A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2)

Background Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. Objective In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). Methods This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. Results This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. Conclusions This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. Trial Registration ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105 International Registered Report Identifier (IRRID) RR1-10.2196/28141

‘Swinging the lead and working the head’ – An explanation as to why mental illness stigma is prevalent in policing

Policing can be injurious to the mental health of those delivering the service. The causes can be operational, organisational or a mixture of both. Mental health related stigma is prevalent within policing; thus, help seeking is avoided. Those who do seek help are often thought to be malingerers. Managers are considered to be ill equipped to identify and support those at risk. The processes and policies that are meant to support recovery do not meet the needs of the officers and staff living and working with mental ill health. Consequently, disclosing a mental health issue is seen as career destroying.

Recovery capital among people receiving treatment for opioid use disorder with buprenorphine

Background Recovery is a multidimensional process that includes health, quality of life, and citizenship. Recovery capital is a strengths-based concept representing the sum of an individual’s resources that support recovery. This study (1) describes recovery capital, (2) examines the relationship between recovery capital and treatment duration, and (3) assesses differences by gender in recovery capital among people receiving medication for opioid use disorder (MOUD). Methods This is a secondary data analysis of a cross-sectional study, with survey and medical record review components, conducted with patients recruited from an office-based opioid treatment clinic between July and September 2019. Analyses included participants receiving MOUD with buprenorphine who completed the Brief Assessment of Recovery Capital (BARC-10; n = 130). Univariate analyses explored differences by gender. Multivariate linear regression assessed the relationship between BARC-10 total score and length of current treatment episode. Results Participants were 54.6% women and 67.4% Black with mean age of 42.4 years (SD = 12.3). Mean length of current MOUD treatment was 396.1 days (SD = 245.9). Total BARC-10 scores were high, but participants perceived low community-level resources. Women scored higher than men within the health and purpose recovery dimensions. While length of treatment was not associated with BARC-10 score, experiencing recent discrimination was associated with a significantly lower BARC-10 score. Conclusions Recovery capital among individuals receiving MOUD was high suggesting that participants have resources to support recovery, but gender differences and prevalent discrimination highlight areas for improved intervention. More work is needed to investigate recovery capital as an alternative treatment outcome to abstinence in outpatient MOUD populations.