Participation in mental healthcare: a qualitative meta-synthesis

Background

Facilitation of service user participation in the co-production of mental healthcare planning and service delivery is an integral component of contemporary mental health policy and clinical guidelines. However, many service users continue to experience exclusion from the planning of their care. This review synthesizes qualitative research about participation in mental healthcare and articulates essential processes that enable service user participation in mental health care.

Methods

Electronic databases were systematically searched. Studies were included if they were peer reviewed qualitative studies, published between 2000 and 2015, examining participation in mental health care. The Critical Appraisal Skills Program checklist was used to assess the quality of each included study. Constant comparison was used to identify similar constructs across several studies, which were then abstracted into thematic constructs.

Results

The synthesis resulted in the identification of six principal themes, which articulate key processes that facilitate service user participation in mental healthcare. These themes included: exercising influence; tokenism; sharing knowledge; lacking capacity; respect; and empathy.

Conclusions

This meta-synthesis demonstrates that service user participation in mental healthcare remains a policy aspiration, which generally has not been translated into clinical practice. The continued lack of impact on policy on the delivery of mental healthcare suggests that change may have to be community driven. Systemic service user advocacy groups could contribute critically to promoting authentic service user participation in the co-production of mental health services.

     

家庭暴力施暴者的心理学特征及罹患精神障碍的研究

目的 了解家庭暴力施暴者的心理学特征及其罹患精神障碍的状况.方法 对318例家庭暴力施暴者(施暴组)和310名所在地区、家庭结构和家庭身份与施暴组相匹配的无家庭暴力者(对照组),采用症状自评量表(SCL-90)、艾森克个性问卷(EPQ)、特质应对方式问卷(TCSQ)、社会支持评定量表(SSRS)、神经症筛选表,以及精神病筛选表进行评估.结果 (1)施暴组的SCL-90总分以及躯体化、强迫、人际敏感、抑郁、焦虑、敌对、恐惧、偏执、精神病和附加因子分均高于对照组(P＜0.05～P＜0.01);EPQ中的神经质评分(48.3±10.2)分高于对照组[(45.3±10.0)分,P＜0.01];TCSQ中的消极应对分(29.61±8.28)分高于对照组[(26.97±7.28)分,P＜0.01];SSRS中的社会支持总分(37.42±8.22)分、客观支持分(12.17±3.54)分、主观支持分(17.79±5.01)分以及对社会支持的利用度(7.42±2.04)分均低于对照组[分别为(40.79±6.56)分、(12.82±3.01)分、(20.15±4.04)分、(7.82±1.96)分;均P＜0.05～0.01].(2)精神疾病检出率:施暴组(6.9%,22例)的高于对照组(1.3%,4例;P＜0.01).(3)Logistic回归:敌对因子(P=0.011,OR=1.665)、消极应对方式(P=0.037,OR=1.027)和重性精神疾病(P=0.033,OR=9.597)是施暴的危险因子,主观支持是施暴的保护因子(P=0.000,OR=0.909).结论 家庭暴力施暴者存在较多的心理问题和较高的精神障碍检出率,他们也需要心理干预、医学干预和社会支持.     

The mental health and psychosocial effects of organized violence: A qualitative study in northern Haiti

Historically, organized violence has been a chronic pervasive problem in Haiti. We set out to elicit Haitians' views on its effects to guide the development of interventions. In March 2006 we studied a population in the slum area of Cap-Haitien, Haiti's second largest city, and the nearby towns of Milot and Limbe. A convenience sample of adults was asked to free list all current problems affecting victims of organized violence. Two major categories emerged: psychological problems and financial problems. The psychological problems of "feeling startled and loss of self control," "sadness/grief," "continuing to suffer from reliving/reexperiencing past events," "problems in the head/mental problems," "deep suffering in the heart," and "thinking too much" emerged as themes from key-informant interviews. These may correspond to constructs of depression, dysthymia, and anxiety disorders including posttraumatic stress disorder in psychiatric nosology. The development of effective interventions can therefore consider those known to be effective for these problems in other settings. However in selecting interventions, considerations must also include local acceptability, perceived causes of problems, and their social effects.     

Improving mental health service responses to domestic violence and abuse

Abstract

Domestic violence and abuse is a considerable international public health problem, which is associated with mental disorders in both women and men. Nevertheless, victimization and perpetration remain undetected by mental health services. This paper reviews the evidence on mental health service responses to domestic violence, including identifying, referring, and providing care for people experiencing or perpetrating violence. The review highlights the need for mental health services to improve rates of identification and responses to domestic violence and abuse, through the provision of specific training on domestic violence and abuse, the implementation of clear information sharing protocols and evidence-based interventions, and the establishment of care referral pathways. This review also highlights the need for further research into mental health service users who perpetrate domestic violence and abuse.     

Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

Worldwide, growing concern with young people’s mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11–30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes—initiating contact with mental health services; characteristics of services’ response; and youths’ and carers’ appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths’ pathways to them. It underlines the need for grounding reform in youths’ and carers’ perspectives and needs.

     

Correction to: Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review

Social Psychiatry and Psychiatric Epidemiology - The original article can be found online.     

Partner violence screening in mental health

Objective

To study a mental health sample to assess (1) the prevalence of physical, sexual and emotional intimate partner violence (IPV) victimization and perpetration, (2) the extent this sample reported being asked about IPV by mental health clinicians and (3) how prevalence and screening rates varied by gender.

Method

Women and men receiving services at a large psychiatric facility completed anonymous written questionnaires.

Results

A total of 524 adults were approached for study participation, and 428 (158 men, 270 women) completed a survey. Over half (51%) of participants experienced some form of IPV; 63% of women and 32% of men reported IPV victimization. Experience of IPV was more likely if participants were women and had diagnoses of posttraumatic stress disorder, anxiety disorder or bipolar disorder. Both women (33%) and men (16%) reported perpetrating IPV. The reported IPV screening rate by mental health providers was 44% for the whole sample (women: 55%; men: 27%).

Conclusion

IPV victimization and perpetration is a prevalent problem among women and men receiving mental health services. Clinicians are missing opportunities to screen for IPV as part of mental health evaluation and treatment.     

Mass violence and mental health

Current models of focal epilepsy indicate that damaged cells in the centre of the focus are continuously firing abnormally. For a seizure to arise, these cells must recruit surrounding neurones. It is thus logical that if these neuronal pools which have to be recruited for a seizure to occur, can be modified by behavioural training, then seizure activity can be modified. Conditioning of seizure activity is possible and has been demonstrated in animals, as has the influence on seizure frequency of social cues. These factors suggest that behavioural modification of the cells activity surrounding the focus and modification of the patient's behaviour can significantly alter seizure frequency.     

Domestic violence and mental health

There are clear gender differences in the experience of domestic violence and associated mental health outcomes. There is also increasing evidence of chronic, severe and often long-term adverse mental health effects for victims. This paper explores these gender differences and the evidence on how mental health care services should respond to domestic violence. The authors argue that any strategy to reduce the burden of women's mental health problems should include efforts to identify, prevent or reduce violence against women.     

Domestic violence and mental health

There are clear gender differences in the experience of domestic violence and associated mental health outcomes. There is also increasing evidence of chronic, severe and often long-term adverse mental health effects for victims. This paper explores these gender differences and the evidence on how mental health care services should respond to domestic violence. The authors argue that any strategy to reduce the burden of women's mental health problems should include efforts to identify, prevent or reduce violence against women.     

Perceptions of mental health and utilization of mental health services among new immigrants in Canada: A qualitative study

The impact of immigration on individuals’ overall health, including mental health, is complex. New immigrants’ concepts of mental health, mental healthcare utilization, and their knowledge of existing services in Regina, Canada were explored using a hermeneutic phenomenological approach. Three focus groups were conducted with 37 participants recruited from English language classes provided by a non-governmental organization in the city. Irrespective of country of origin, participants recognized the impact of mental health on general wellbeing. Access to existing mental healthcare was hindered by language barriers, inadequate information about existing healthcare services, and individuals’ perceptions about what and when services should be accessed. Despite challenges, participants viewed relocation positively and exhibited resilience when dealing with daily stress. Participants had knowledge gaps surrounding the role of family physicians in managing mental health conditions. Information on ways to access existing healthcare services should be delivered in collaboration with community organizations serving new immigrants.

     

Parental violence and adolescent mental health

Being the target of parental violent acts decreases child adjustment and increases the likelihood of mental health problems in childhood and adolescence. Our study analyses how different types of parental violence ranging from verbal threats and swearing to hitting and kicking a child, are associated with child adjustment, indicated by strengths and difficulties scale (SDQ) total problem score, internalizing and externalizing problems as well as prosocial behaviour. We also study whether girls and boys and youths in two Nordic countries respond differently to parental violence. The data consists of a large-scale community sample of 15–16-year old Finnish (n = 5,762) and Danish (n = 3,943) adolescents. The representative data of continental Finland and its Finnish and Swedish speaking ninth graders as well as representative data of Danish ninth grade pupils were collected by the Police College of Finland and in Denmark by the National Institute of Public Health, University of Southern Denmark. The results show a clear dose–response effect between parental violent behaviour and the adolescent’s problems. The more severe forms of parental violence were associated with higher levels of SDQ total difficulties and internalizing and externalizing symptoms. There was also a connection between parental violence and the deterioration of prosocial behaviour. The association was gender and nationality specific. The findings imply a high prevalence of parental violence and adverse mental health among the affected Finnish and Danish adolescents. Though the laws have been set in motion to prevent the use of parental physical violence the challenges remain in several domains of child protection, general health care, prevention and intervention.     

Providing pastoral care service in aged mental health settings: A literature review

The World Health Organization (WHO) specifies that attention to the spiritual needs of the elderly with mental health problems is essential to good patient care, yet little evidence‐based practice is documented in this field. This paper reviews the literature on the provision of pastoral care services (PCS) to elderly people with mental impairment. Integration of Pastoral Care Practitioners (PCPs) into the multidisciplinary team is rare. Research into mental health clinicians' attitudes to addressing patients' spiritual needs, and the integration of PCPs into multidisciplinary teams in aged mental health are reported and discussed. The contextual needs of PCPs in aged mental health, and options for qualitative and quantitative research are explored. Further research is needed to guide the integration of PCS into multidisciplinary teams in aged persons' mental health services.     

Characteristics of staff burnout in mental health settings

To determine the characteristics of staff burnout and ways of coping with it, the authors gathered data on institution-relation and personal variables for 76 staff members in various mental health facilities in the San Francisco area. A correlational analysis revealed a large number of statistically significant findings. For instance, the longer staff had worked in the mental health field, the less they liked working with patients, the less successful they felt with them, and the less humanistic were their attitudes toward mental illness. The authors present recommendations for reducing staff stress and subsequent burnout, including allowing more chances for temporary withdrawal from direct patient care and changing the function of staff meetings.     

Task force report: Sociophysical settings and mental health: Opportunities for mental health services planning

President Kennedy's bold new approach remains compelling 15 years after it was first announced. Mental health services at the community level have come a long way since the community mental health center program's establishment in 1963. Mental health manpower, advances in treatment technology, and volumes of service all have grown remarkably; but much still remains to be done to integrate community mental health services into the communities they serve in the planning of human services generally, and particularly in emphasis on preventive care. The National Council of Community Mental Health Centers Environmental Assessment Task Force has two closely related charges in these latter areas. First, to inquire into the environmental aspects of mental health at the community level; and, second, to explore environmental perspectives for the establishment of prevention initiatives in the delivery of services. This paper explores that charge by seeking a perspective on environment that traces the intersection of the built environment and social-interpersonal behavior with special attention to the implications for mental well-being. Implications of this perspective for community mental health center roles in community planning are considered, with reference to the establishment of preventive services.     

Mass violence and mental health: Attachment and trauma

This article focuses on post-traumatic stress disorder (PTSD) as both one of the most important mental health consequences of mass violence and as the manifestation of a disrupted human attachment system. The implications are many in terms of treatment and prevention. For instance, since the vulnerability to PTSD appears to be transmitted down the generations via the psychobiological manifestations of the parents’ attachment system, prevention requires the effective treatment of afflicted communities within a context of strong social support. More specific guidelines for intervention are outlined focusing on the role of psychosocial workers and their need to be carefully selected, trained and supervised. Failure to tackle the effects of mass violence and to prevent further psychological damage through political action has serious implications in terms of the future of mankind.     

Mass violence and mental health: attachment and trauma

This article focuses on post-traumatic stress disorder (PTSD) as both one of the most important mental health consequences of mass violence and as the manifestation of a disrupted human attachment system. The implications are many in terms of treatment and prevention. For instance, since the vulnerability to PTSD appears to be transmitted down the generations via the psychobiological manifestations of the parents' attachment system, prevention requires the effective treatment of afflicted communities within a context of strong social support. More specific guidelines for intervention are outlined focusing on the role of psychosocial workers and their need to be carefully selected, trained and supervised. Failure to tackle the effects of mass violence and to prevent further psychological damage through political action has serious implications in terms of the future of mankind.