scholarly journals Improving community health networks for people with severe mental illness: a case study investigation

2015 ◽  
Vol 3 (5) ◽  
pp. 1-234 ◽  
Author(s):  
Vanessa Pinfold ◽  
Daryl Sweet ◽  
Ian Porter ◽  
Cath Quinn ◽  
Richard Byng ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Community Health ◽  
Well Being ◽  
Personal Networks ◽  
System Level ◽  
Network Type ◽  
Care System

IntroductionPolicy drivers in mental health to address personal recovery, stigma and poor physical health indicate that new service solutions are required. This study aimed to understand how connections to people, places and activities were utilised by individuals with severe mental illness (SMI) to benefit health and wellbeing.MethodsA five-module mixed-methods design was undertaken in two study sites. Data were collected from 150 network-mapping interviews and 41 in-depth follow-up interviews with people with SMI; in-depth interviews with 30 organisation stakeholders and 12 organisation leaders; and 44 telephone interviews with practitioners. We undertook a three-stage synthesis process including independent lived experience feedback, and a patient and public involvement team participated in tool design, data collection, analysis and write-up.ResultsThree personal network types were found in our study using the community health network approach: diverse and active; family and stable; formal and sparse. Controlled for other factors we found only four variables significantly associated with which network type a participant had: living alone or not; housing status; formal education; long-term sickness or disability. Diagnosis was not a factor. These variables are challenging to address but they do point to potential for network change. The qualitative interviews with people with SMI provided further understanding of connection-building and resource utilisation. We explored individual agency across each network type, and identified recognition of the importance and value of social support and active connection management alongside the risks of isolation, even for those most affected by mental illness. We identified tensions in personal networks, be that relationships with practitioners or families, dealing with the impact of stigma, or frustrations of not being in employment, which all impact on network resources and well-being. The value of connectedness within personal networks of people, place and activity for supporting recovery was evident in shaping identity, providing meaning to life and sense of belonging, gaining access to new resources, structuring routines and helping individuals ‘move on’ in their recovery journey.Health-care practitioners recognised that social factors were important in recovery but reported system-level barriers (workload, administrative bureaucracy, limited contact time with clients) in addressing these issues fully. Even practitioners working in third-sector services whose remit involved increasing clients’ social connection faced restrictions due to being evaluated by outcome criteria that limited holistic recovery-focused practices. Service providers were keen to promote recovery-focused approaches. We found contrasts between recovery ideology within mental health policy and recovery practice on the ground. In particular, the social aspects of supporting people with SMI are often underprioritised in the health-care system. In a demanding and changing context, strategic multiagency working was seen as crucial but we found few examples of embedded multisector organisation partnerships.ConclusionWhile our exploratory study has limitations, findings suggest potential for people with SMI to be supported to become more active managers of their personal networks to support well-being regardless of current network type. The health and social care system does not currently deliver multiagency integrated solutions to support SMI and social recovery.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Barriers to Family Caregivers’ Coping With Patients With Severe Mental Illness in Iran

2018 ◽  
Vol 28 (6) ◽  
pp. 987-1001 ◽  
Author(s):  
Hossein Ebrahimi ◽  
Naeimeh Seyedfatemi ◽  
Hossein Namdar Areshtanab ◽  
Fatemeh Ranjbar ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Family Caregivers ◽  
Qualitative Content Analysis ◽  
Care Delivery ◽  
Interview Method ◽  
Bipolar Affective Disorders

The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers’ experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers’ ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient’s isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.

“Hear me out”: Experiences of mothers suffering from severe mental illness with health care providers – A qualitative perspective

2017 ◽  
Vol 41 (S1) ◽  
pp. s899-s899 ◽  
Author(s):  
D. Banerjee ◽  
G. Desai ◽  
P.S. Chandra
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Health Care Providers ◽  
Service Providers ◽  
Care Providers ◽  
Structured Interviews ◽  
Seeking Help ◽  
Competing Interest

BackgroundContrary to popular myth, majority of mentally ill women are mothers with increasing number of them seeking help. Little is known about their own experiences in this regard and the extent to which their needs are met.ObjectivesTo assess the barriers and facilitators in seeking help from mental health care providers in matters of pregnancy and parenting.MethodsThe study used qualitative design with social constructivist paradigm. A purposive sample of 30 mothers with severe mental illness was obtained. Data was collected through one-to-one in-depth semi-structured interviews. After verbatim transcription, inductive thematic analysis was used to explore transcripts.ResultsMost women considered motherhood “central” to their lives and almost all of them experienced the burden of the “dual role”. Main barriers in seeking help were stigma, treatment side effects, wrong information and time constraints. Whereas self-advocacy, early engagement, education of women and involvement of the family with service providers were the facilitating factors. The prime expectations of the mothers as identified were early and direct communication, patient audience and basic guidance in regards to child health and parenting issues.ConclusionWomen who are mothers and also users of mental health services face special challenges in managing the contradictory aspects of their dual identity. Hearing their voices are essential for service provision and ensuring adequate mental health needs. Early and direct intervention along with understanding and addressing critical areas are necessary for proper care of both the mother and child.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries

2016 ◽  
Vol 26 (4) ◽  
pp. 348-354 ◽  
Author(s):  
C. Hanlon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Human Rights ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Mental Health Professionals ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries

The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development, borne out of powerful advocacy using public health, economic and human rights arguments. As funding comes on line for scale-up of evidence-based mental health care by task-sharing with primary care, it is time to take stock about care for people affected by severe mental illness (SMI). The existing evidence base for task shared care for SMI provides an imperative to get started, but is skewed towards relatively more affluent and urban populations in middle-income countries where specialist mental health professionals provide most of the care. Randomised, controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving understanding of the quality, safety, effectiveness and acceptability of more widely generalisable care for people with SMI. A sub-group of people with SMI have more complex and long-term needs for care, with a high risk of homelessness, imprisonment and human rights violations as family and social supports become overwhelmed. Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation, recovery and empowerment of people with SMI, but rigorous comparative studies are needed to identify the most efficient, effective and scalable approaches to care. Health system constraints are emerging as the over-riding barriers to successful task-sharing, highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality, improving wellbeing and achieving better social outcomes. Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI.

scholarly journals Review Sistematik: Model Pemulihan Penderita Gangguan Jiwa Berat Berbasis Komunitas

2020 ◽  
Vol 1 (2) ◽  
pp. 123-129
Author(s):  
Retno Lestari ◽  
Ah Yusuf ◽  
Rachmat Hargono ◽  
Febri Endra Budi Setyawan
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Social Life ◽  
Holistic Approach ◽  
Recovery Process ◽  
Well Being ◽  
Community Mental Health Service ◽  
Community Members ◽  
Life Planning

People with severe mental illness have complex disabilities affecting mental functions, daily activities, and social life, thus they need help from others in carrying out daily functional activities. Optimizing the recovery of severe mental illness requires a holistic approach and integration between mental health services and supportive communities so that sufferers can interact with others, have a positive self-concept, and improve their well-being. This study aims to describe a community-based model of recovery for people with severe mental illness. Several literature studies were obtained from 50 reference sources through Science Direct, Google Scholar, Proquest Health and Medical Complete, Proquest Nursing, and Allied Health Sources from 2009 to 2019. Results explain that the community provides an adequate support system in improving the care of people with severe mental illness. Support systems in the community involve social and physical aspects as well as the economic infrastructure through employment opportunities or financial support and a decent living. The interaction between community members and people with severe mental illness could be a positive thing in strengthening the motivation of people with severe mental illness to recover and be able to do their activities independently. The recovery process of severe mental illness requires strong motivation and commitment from the sufferer, the family, all society members, community mental health service team, and related policymakers. It can be concluded that people with severe mental illness need support from various parties in terms of future life planning, identifying strengths and weaknesses that they have, and recognizing multiple obstacles and support so that they recover and live independently.

scholarly journals Pathways Into and Out of Homelessness Among People with Severe Mental Illness in Rural Ethiopia: A Qualitative Study

2020 ◽  
Author(s):  
Caroline Smartt ◽  
Kaleab Ketema ◽  
Souci Frissa ◽  
Bethlehem Tekola ◽  
Rahel Birhane ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Low Income ◽  
Community Intervention ◽  
Social Needs ◽  
Rural Setting ◽  
Study Participants

Abstract Background: Little is known about the pathways followed into and out of homelessness among people with severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia.Methods: In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through a larger project implementing a multi-component district level plan to improve access to mental health care in primary care (PRIME). Thematic analysis was conducted using an inductive approach.Results: Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return.Conclusions: Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Interventions to prevent and tackle homelessness need to focus on increasing family support, and ensuring access to housing, mental health care and social support.

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