Evaluation of an anti-stigma intervention for Mexican psychiatric trainees

Background There is research evidence regarding the presence of stigmatising attitudes in psychiatrists towards people with mental illness, but a lack of studies and interventions focused on this issue in low and middle-income countries. Aims To assess the feasibility of implementing an anti-stigma intervention for Mexican psychiatric trainees, and its potential effects. Methods This study comprised a pre-post design with outcome measures compared between baseline and 3-month follow-up. Quantitative outcome measures were used to evaluate the potential effects of the intervention, whilst the process evaluation required the collection and analysis of both quantitative and qualitative data. Results Twenty-nine trainees (25% of those invited) participated in the intervention, of whom 18 also participated in the follow-up assessment. Outcome measures showed the intervention had moderately large effects on reducing stereotypes and the influence of other co-workers on trainees’ own attitudes. The main mechanisms of impact identified were recognition of negative attitudes in oneself and colleagues, self-reflection about the impact of stigma, one’s own negative attitudes and recognition of one’s ability to make change. Participants accepted and were satisfied with the intervention, which many considered should be part of their routine training. However, trainees’ work overload and lack of support from the host organisation were identified as barriers to implement the intervention. Conclusions A brief anti-stigma intervention for Mexican psychiatric trainees is feasible, potentially effective, well accepted and was considered necessary by participants. This study also suggests mechanisms of impact and mediators should be considered for developing further interventions, contributing to reducing the damaging effects that mental health-related stigma has on people’s lives.

Mental illness due to homelessness: a qualitative case study in Melaka, Malaysia

Background: Extreme poverty can result in people barely surviving with poor living standards to the extent of living on the streets, often in fear. With limited access to healthcare services and a clean environment, they are more vulnerable to life adversities. Highly stressful living conditions like these can cause mental illnesses such as depressive disorders, anxiety disorders, psychological distress, and others. Purpose: This research aimed to investigate factors that led to the development of mental illness among homeless people under extreme poverty. Design/methodology/approach: This was a qualitative case study that involved a face-to-face interview with a key informant at the Pertubuhan Kebajikan Villa Harapan Melaka (Villa Harapan). Villa Harapan is a licensed caretaker centre established by the Department of Welfare, Melaka that provides shelter to homeless people with mental illness. Findings: Homeless people suffered from mental disturbances due to loss of jobs, lack of income, broken families, separation from their children, and other vulnerabilities. They are not getting appropriate care and attention for their problem and sickness. Non-supportive family, extreme poverty, and chronic stress were the main factors that led to mental illness among Villa Harapan residents. Research limitations: The study focused on the mental illness of dispossessed people who were brought to Villa Harapan by the Welfare Department. Originality/value: This was an empirical case study on mental illness among homeless people at a care centre known as Villa Harapan.

Rehabilitasi Psikososial Untuk Mewujudkan Orang dengan Gangguan Jiwa Bermartabat di Wilayah Kerja Puskesmas Sunggal Medan

ABSTRAKPeningkatan kasus COVID 19 dan penerapan pemberlakuan pembatasan kegiatan masyarakat di Kota Medan mengakibatkan kegiatan pelayanan kesehatan jiwa masyarakat terhenti. Salah satu prioritas masalah di wilayah kerja Puskesmas Sunggal adalah gangguan jiwa. Situasi saat ini banyak penderita yang tidak teratur minum obat, tidak kontrol ke puskesmas atau rumah sakit, mengalami kekambuhan dan tidak mematuhi protokol kesehatan bila keluar rumah serta tidak produktif. Kegiatan ini bertujuan untuk meningkatkan fungsi sosial dan keterampilan orang dengan gangguan jiwa. Target khusus yang ingin dicapai adalah perubahan perilaku dari ODGJ dan keluarga di wilayah kerja Puskesmas Sunggal Medan. Metode yang digunakan adalah ceramah, diskusi dan tanya jawab, home visit, pengembangan bakat dan minat pasien berupa pelatihan dan pendampingan pembuatan sabun cair. Hasil yang diperoleh dari kegiatan ini adalah 12 orang dari 15 ODGJ (80%) dapat mengontrol gejala pskotik, kontrol teratur ke puskesmas sebelum obat habis dan mempunyai keterampilan membuat sabun cair serta mampu mengembangkan keterampilan lainnya sesuai dengan minat dan bakat masing-masing. Rehabilitasi psikosoial memberikan dampak positif bagi peningkatan fungsi kognitif, psikomotor dan afektif orang dengan gangguan jiwa. Keberhasilan program ini membutuhkan partisipasi aktif dari semua pihak. Kata Kunci : Rehabilitasi, psikososial, orang dengan gangguan jiwa, bermartabat ABSTRACTThe increase in cases of COVID 19 and the implementation of restrictions on community activities in the city of Medan resulted in community mental health service activities being stopped. One of the priority problems in the work area of the Sunggal Health Center is mental disorders. The current situation was people with mental illness did not regularly take medication, did not go to the community health center or hospital to see the Doctor, experience relapses and did not comply with health protocols when leaving the house, and was unproductive. The activity aims to improve the social functioning and skills of people with mental disorders. The specific target to be achieved is to change the behavior of ODGJ and their families in the working area of the Sunggal Community Health Center, Medan. The methods used were lectures, discussions and questions and answers, home visits, identifying talents and interests of patients in the form of training and assistance in making liquid soap. The results of the activities were 12 from 15 of people with mental illness (80@) can control psychotic symptoms, regularly visit "the puskesmas" before the drugs run out and have the skills to make liquid soap, and are able to develop other skills according to their respective interests and talents. Psychosocial rehabilitation has a positive impact on improving the cognitive, psychomotor, and affective functions of people with mental disorders. The success of this program requires the active participation of all parties. Keywords: rehabilitation, psychosocial, people with mental illness, dignity

Exploration of the Independent Housing Experience of People with Mental Illness in a Community

Purpose: This study aims to explore the independent housing experiences of people with mental illness who receive supported independent housing services provided by the public sector.Methods: Data were collected through face-to-face interviews using semi-structured interviews. Twelve participants, who had been living independently in the community for around 11 months, were included. A qualitative descriptive method and a content analysis method were applied.Results: Independent housing experiences of people with mental illness were classified into the following four domains: house effect, growth, challenges and limitations, relationships, and support. Eleven categories included the starting point of life, environmental & psychological comfort, inspire independence and confidence, recognition of goals and responsibilities, positive self-awareness, psychological difficulties, immaturity of daily coping, unstable self-protection, relationship improvement, and importance of support resources.Conclusion: For successful community integration of mentally disabled people, continuous legal institutional preparation for stable housing, government active interest, and flexible financial support are needed. In addition to housing support, a recovery-based independent housing case management model needs to be developed for successful maintenance of independent living. We also suggest a study on the effectiveness of independent housing to determine evidence for making a policy.

Deinstitutionalization in Macro Practice

The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as trans-institutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, expanding admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase and model programs illustrating what can be done; yet, it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. It has been documented, from political, economic, legal, and social perspectives, how this policy has affected the care and control of populations such as older adults, children, people with mental illness or developmental disabilities, people under correctional-system supervision, and, more recently, individuals without a home. Suggestions for a truer implementation of deinstitutionalization’s initial aspirations are available.

COVID-19 Vaccination Rates in a Cohort Study of Patients With Mental Illness in Residential and Community Care

Background: Patients with mental illness are at increased risk for COVID-19-related morbidity and mortality. Vaccination against COVID-19 is important to prevent or mitigate these negative consequences. However, concerns have been raised over vaccination rates in these patients.Methods: We retrospectively examined vaccine uptake in a large sample of Belgian patients admitted to or residing in a university psychiatric hospital or community mental health care setting between 29th of March 2021 and 30th of September 2021 in the Flanders Region. All patients were offered vaccination. Descriptive statistics were used to analyse the data. Logistic regression was used to examine factors associated with vaccine uptake.Results: 2,105 patients were included in the sample, of which 1,931 agreed to be vaccinated, corresponding with a total vaccination rate of 91.7%. Logistic regression showed an effect of the diagnosis “other disorders” (OR = 0.08, CI = 0.005–0.45), age (OR = 1.03, CI = 1.02–1.04) and residing in the psychosocial care center (OR = 0.50, CI = 0.32–0.80) on vaccination status.Conclusion: Vaccine uptake among people with mental illness is high and comparable to the general population, when implementing a targeted vaccination program.

Advancing research in adult secure mental health services in England

Forensic mental health services in high income countries are typically high cost and low volume, providing care to people with mental illness, personality disorders, learning disability and autism deemed to pose a risk to others. Research into how forensic mental health services work as a whole system is limited. Such research is urgently needed to guide policy makers and ensure that services operate effectively.

Mediators for the Effect of Compassion Cultivating Training: A Longitudinal Path Analysis in a Randomized Controlled Trial Among Caregivers of People With Mental Illness

Background: There is a paucity of research on mediators of change, within compassion training programs. The aim was to investigate the mediators, of an 8-week compassion cultivation training (CCT) program, on the effect of psychological distress on caregivers of people with a mental illness.Method: Longitudinal path models in a randomized controlled trial (RCT). One hundred ninety-two participants were assessed for eligibility, and 161 participants were included into the trial and randomized. The main outcome was psychological distress measured by the Depression, Anxiety and Stress scale at 6 months. Mediators included self-compassion (SC), mindfulness (FM), emotion regulation (ER), emotion suppression (ES), and cognitive reappraisal (CR). Baseline, post, and 3- and 6-month follow-up measurements were collected.Results: The mediated effects for CCT are as follows: depression at 6 months: SC: −1.81 (95% CI: −3.31 to −0.31); FM: −1.98 (95% CI: −3.65 to −0.33); ER: −0.14 (95% CI: −1.31 to 1.02); anxiety at 6 months: SC: −0.71 (95% CI: −1.82 to 0.40); FM: −1.24 (95% CI: −2.39 to −0.09); ER: 0.18 (95% CI: −1.04 to 1.40); stress at 6 months: SC: −1.44 (95% CI: −2.84 to −0.05); FM: −2.17 (95% CI: −3.63 to −0.71); ER: −0.27 (95% CI: −1.51 to 0.98).Conclusion: Mindfulness and self-compassion are important components in reducing psychological distress experienced by informal caregivers of people with a mental illness. Results contribute to the knowledge about the underlying mechanisms of CCT.

Integrating mental health into primary care: Evaluating the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria, using the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) to treat common mental and neurological disorders in the primary care setting. This study evaluates the impact of the HAPPINESS pilot project training on trainees’ beliefs and attitudes about mental disorders and explores the perspectives of trainees, trainers, and health services officials on its implementation using a convergent, mixed-methods approach. Methods Trainees completed a 43-item questionnaire, before and after their 5-day training, to assess perceptions of mental disorders and attitudes towards people with mental illness. Paired-sample t-tests were conducted with respect to four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured Key Informant Interviews with trainees, trainers, and local health officials who participated in or supported the HAPPINESS Project were also analyzed. Findings from the questionnaire and interviews were merged using a convergent, mixed method approach. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. The HAPPINESS Project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Lastly, respondents suggested ways that the HAPPINESS Project could be improved and expanded in the future. Conclusion This study adds to the limited existing evidence on the impact of mhGAP-IG-based training for primary care workers in Nigeria. Notably, it quantitatively evaluates pre and post training change in stigma level among trainees. Future efforts should focus on clinical support, supervision and implementation outcomes as well as scaling up and assessing the cost-effectiveness of the HAPPINESS Project intervention.