Effectiveness of Criminal Justice Liaison and Diversion Services for Offenders With Mental Disorders: A Review

Objective: The authors evaluated and synthesised the best-available evidence relating to the effectiveness of CJLD service models with respect to changes in mental health status and/or criminal recidivism.Methods: Research examining the effectiveness of CJLD services when compared to traditional Criminal Justice System (CJS) responses was reviewed and systematically appraised according to Campbell/Cochrane guidelines. Key outcomes included a reduction in offending and post-intervention changes in mental health. Results: Comprehensive searches of published and unpublished literature identified 6571 studies which varied considerably in terms of their methodological approach and overall quality. Ten studies met the inclusion criteria. The synthesised findings indicated that, when compared to traditional CJS outcomes, CJLD services appeared to be effective in terms of identifying MDOs and impacting positively on criminal justice and mental health outcomes.Conclusions: Although the evidence may be deemed to be moderate in terms of methodological rigour, overall, the findings suggest that CJLD services can be beneficial. The effectiveness of services depends upon the model of service delivery, the availability of community services and the engagement of MDOs.The successful implementation of CJLD services requires a clearer recognition of the importance of system of care principles.

Applying the recovery approach to the interface between mental health and child protection services

There are a range of theoretical approaches which may inform the interface between child protection and adult mental health services. These theoretical perspectives tend to be focused on either child protection or mental health with no agreed integrating framework. The interface continues to be identified, in research, case management reviews and inquiry reports, as complex and problematic. This paper proposes that more positive, integrated approaches to service user engagement, risk assessment and management may lead to better outcomes in working with families experiencing parental mental health problems and child protection concerns. It is proposed that the recovery approach, increasingly used in mental health services, can inform the processes of engagement, assessment and intervention at the mental health and child protection interface. The article provides a critical overview of the recovery approach and compares it with approaches typifying interventions in child protection work to date. Relevant research and inquiries are also examined as a context for how to more effectively respond to cases where there are issues around parental mental health problems and child protection. The article concludes with case material to illustrate the potential application of the recovery approach to the interface between mental health and child protection services.

Responding to mental health statutory drivers: experience of a low intensity cognitive behavioural therapy programme

Objectives Stress control (SC), a brief psycho-education course, was implemented to increase access to psychological therapies in line with Northern Irish mental health service statutory drivers. The first aim of this study was to gauge the efficacy of SC in a robust manner with clinical significance testing. The second aim was to assess whether demographics traditionally ‘hard-to-reach’ – males, younger adults and those from deprived areas – accessed SC. The third aim was to elucidate what prompted their access and the experiences of attendees at SC. Methods Attendees at SC were 170 adults over six iterations of the course. Pre- and post-questionnaires included the Depression Anxiety Stress Scales – 21, captured demographic details and qualitative feedback, which was subject to a mixed-methods analysis. Results SC attendees reported significant decreases on depression, anxiety and stress sub-scales post-intervention. Moreover, 38.71% ( n =36) of attendees who completed SC exhibited clinically significant improvement afterwards on one or more sub-scale. Attendance figures for males, younger adults and those classified as socioeconomically deprived were modest. Patterns within the data suggested prospective success for targeting these cohorts. Conclusions SC attracted people in need of mental healthcare input and affected quantifiable change within those people’s lives, while satisfying statutory demands for service delivery in an accessible community context. Recommendations to increase engagement with those traditionally ‘hard-to-reach’ for psychological services are provided, which, if implemented, have the potential to achieve further compliance with Northern Irish mental health statutory drivers.

Working with the complexities of adolescent mental health problems: applying Time‐limited Adolescent Psychodynamic Psychotherapy (TAPP)

This article discusses the application in a CAMHS setting of a distinctive intervention for adolescent mental health difficulties, Time‐limited Adolescent Psychodynamic Psychotherapy (TAPP). TAPP has been developed specifically for working with adolescents and the characteristic developmental and psychosocial complexities they present to mental health services. It is widely recognised that supporting the developmental process in adolescence is central to therapeutic interventions and the therapeutic aim of TAPP is to enable recovery of the capacity to meet developmental challenges. The key factors of TAPP are described, including the formulation and working with a developmental focus, the therapeutic stance, working with transference and counter‐transference, working with time limits, and the emphasis on engagement of adolescents in therapy in TAPP. The experiences of introducing and developing TAPP in the CAMHS service are discussed with two brief and one extended case examples and this leads to a discussion of the kinds of outcomes achieved. It is concluded that TAPP is a key and relevant intervention for adolescents in complex and vulnerable situations; further work will be undertaken to continue its application in these settings and to formally assess outcomes.

Barriers preventing the successful integration of mental health services into Primary Health Care in Nigeria : a mixed methods approach

RESUMO: A Nigéria tem uma população estimada em cerca de 170 milhões de pessoas. O número de profissionais de saúde mental é muito diminuto, contando apenas com 150 psiquiatras o que perfaz aproximadamente um rácio de psiquiatra: população de mais de 1:1 milhão de pessoas. O Plano Nacional de Saúde Mental de 1991 reconheceu esta insuficiência e recomendou a integração dos serviços de saúde mental nos cuidados de saúde primários (CSP). Depois de mais de duas décadas, essa política não foi ainda implementada. Este estudo teve como objetivos mapear a estrutura organizacional dos serviços de saúde mental da Nigéria, e explorar os desafios e barreiras que impedem a integração bem-sucedida dos serviços de saúde mental nos cuidados de saúde primários, isto segundo a perspectiva dos profissionais dos cuidados de saúde primários. Com este objetivo, desenvolveu-se um estudo exploratório sequencial e utilizou-se um modelo misto para a recolha de dados. A aplicação em simultâneo de abordagens qualitativas e quantitativas permitiram compreender os problemas relacionados com a integração dos serviços de saúde mental nos CSP na Nigéria. No estudo qualitativo inicial, foram realizadas entrevistas com listagens abertas a 30 profissionais dos CSP, seguidas de dois grupos focais com profissionais dos CSP de duas zonas governamentais do estado de Oyo de forma a obter uma visão global das perspectivas destes profissionais locais sobre os desafios e barreiras que impedem uma integração bem-sucedida dos serviços de saúde mental nos CSP. Subsequentemente, foram realizadas entrevistas com quatro pessoas-chave, especificamente coordenadores e especialistas em saúde mental. Os resultados do estudo qualitativo foram utilizados para desenvolver um questionário para análise quantitativa das opiniões de uma amostra maior e mais representativa dos profissionais dos CSP do Estado de Oyo, bem como de duas zonas governamentais locais do Estado de Osun. As barreiras mais comummente identificadas a partir deste estudo incluem o estigma e os preconceitos sobre a doença mental, a formação inadequada dos profissionais dos CPS sobre saúde mental, a perceção pela equipa dos CSP de baixa prioridade de ação do Governo, o medo da agressão e violência pela equipa dos CSP, bem como a falta de disponibilidade de fármacos. As recomendações para superar estes desafios incluem a melhoria sustentada dos esforços da advocacia à saúde mental que vise uma maior valorização e apoio governamental, a formação e treino organizados dos profissionais dos cuidados primários, a criação de redes de referência e de apoio com instituições terciárias adjacentes, e o engajamento da comunidade para melhorar o acesso aos serviços e à reabilitação, pelas pessoas com doença mental. Estes resultados fornecem indicações úteis sobre a perceção das barreiras para a integração bem sucedida dos serviços de saúde mental nos CSP, enquanto se recomenda uma abordagem holística e abrangente. Esta informação pode orientar as futuras tentativas de implementação da integração dos serviços de saúde mental nos cuidados primários na Nigéria.------------ABSTRACT: Nigeria has an estimated population of about 170 million people but the number of mental health professionals is very small, with about 150 psychiatrists. This roughly translates to a psychiatrist:population ratio of more than 1:1 million people. The National Mental Health Policy of 1991 recognized this deficiency and recommended the integration of mental health into primary health care (PHC) delivery system. After more than two decades, this policy has yet to be implemented. This study aimed to map out the organizational structure of the mental health systems in Nigeria, and to explore the challenges and barriers preventing the successful integration of mental health into primary health care, from the perspective of the primary health care workers. A mixed methods exploratory sequential study design was employed, which entails the use of sequential timing in the combined methods of data collection. A combination of qualitative and uantitative approaches in sequence, were utilized to understand the problems of mental health services integration into PHC in Nigeria. The initial qualitative phase utilized free listing interviews with 30 PHC workers, followed by two focus group discussions with primary care workers from two Local Government Areas (LGA) of Oyo State to gain useful insight into the local perspectives of PHC workers about the challenges and barriers preventing successful integration of mental health care services into PHC. Subsequently, 4 key informant interviews with PHC co-ordinators and mental health experts were carried out. The findings from the qualitative study were utilized to develop a quantitative study questionnaire to understand the opinions of a larger and more representative sample of PHC staff in two more LGAs of Oyo State, as well as 2 LGAs from Osun State. The common barriers identified from this study include stigma and misconceptions about mental illness, inadequate training of PHC staff about mental health, low government priority, fear of aggression and violence by the PHC staff, as well as non-availability of medications. Recommendations for overcoming these challenges include improved and sustained efforts at mental health advocacy to gain governmental attention and support, organized training and retraining for primary care staff, establishment of referral and supportive networks with neighbouring tertiary facilities and community engagement to improve service utilization and rehabilitation of mentally ill persons. These findings provide useful insight into the barriers to the successful integration of mental health into PHC, while recommending a holistic and comprehensive approach. This information can guide future attempts to implement the integration of mental health into primary care in Nigeria.

Extension of the Job Demands-Resources model in the prediction of burnout and engagement among teachers over time. 'Una ampliaci??n del modelo de demandas-recursos laborales en la predicci??n del burnout y del engagement en profesores'

Resumen tomado de la publicaci??n. Resumen tambi??n en ingl??s

Niveles de burnout y engagement en estudiantes universitarios : relación con el desempeño y desarrollo profesional.

Resumen tomado del autor. Incluido en el monográfico ïReflexiones sobre política educativaï

Training general practitioners in the assessment of childhood mental health problems

Epidemiological studies have found that most children with mental health problems are not receiving appropriate help. The aim of this study was to assess an approach to train general practitioners (GPs) to detect mental health problems early, engage the families, and assist them in the access of service. Five GPs were given three hours of training on a brief assessment method. Each then interviewed parents whose children they suspected might have a mental health problem. An experienced research clinician then repeated the assessment. This information was fed back to the GP who then assisted the family in obtaining appropriate help. Twenty-nine parents were interviewed in six months. The research clinician and the GPs were in agreement for 90% of the cases for the recognition of mental health problems. GPs’ opinions on the brief assessment method were: easy to use (100%), helpful in obtaining information (100%) and helpful in engaging the parent (100%). The parents were followed up by telephone 3-4 months after the interview. Eighty-eight percent reported that the process was helpful, 67% had received help from services and 67% had improved. We conclude that with brief training, the GPs in this study were able to improve their capacity to provide early intervention for childhood mental health problems.

The recovery journey : employment support for people with depression and other mental illnesses

This paper presents the qualitative findings of a larger mixed method study aimed to articulate factors that clients and staff of the Disability Employment Network (DEN) identify in relation to re-engagement into the workforce. The DEN is a supported job training and employment program funded by the Australian Federal Government, established to assist clients with health disabilities, including mental health diagnoses, to seek and retain employment. Two DEN sites participated in the study (one regional and one metropolitan). Semi structured interviews and focus groups were undertaken with seven employment counsellors and 16 clients until data saturation occurred. Analysis of the narrative data identified two overarching emergent concepts articulated by clients and employment counsellors: employment enablers and employment barriers. The notion of recovery and re-engagement in the workforce in the context of mental illness is complex. The qualitative results of this study highlight the essential nature of supporting clients’ mental health and vocational needs concurrently through such means as service collaboration, vocational peer support and, importantly, provision of employment support congruent with phase of recovery.

Doctoral graduates in mental health nursing in Victoria, Australia : the doctoral experience and contribution to scholarship

The last decade has seen a substantial increase in the number of psychiatric or mental health nurses in Victoria, Australia who hold doctoral qualifications. The literature refers to the importance of scholarship for the professional development and recognition of nursing as a discipline. However, there is a paucity of literature addressing the contribution of nursing doctoral graduates to scholarship in mental health nursing or indeed the broader nursing profession. This paper presents the findings from a survey of psychiatric nurse doctoral graduates currently residing in the State of Victoria. A questionnaire was developed by the authors and distributed to the known doctoral graduates. The main findings demonstrate considerable variation in the discipline and topic of inquiry and in the extent to which doctoral studies had led to dissemination of research findings and engagement in further scholarly activity. The strengthening of mental health nursing knowledge requires scholarship and doctoral graduates are expected to make a major contribution, through research and the dissemination of findings. This paper presents a descriptive overview of doctoral graduates in one State of Australia with a particular focus on research and scholarship.

Contact with nature and children's mental, emotional, and social health

This research investigated the benefits of children's contact with nature as perceived by adult educators. It was found that contact with nature is perceived to: increase self-confidence and self-esteem; provide opportunities to experience mystery, privacy, and sensory engagement; connect children with school; and accommodate different learning styles and abilities.

Factors facilitating successful engagement among patients with first-episode psychosis

This thesis investigated factors that facilitate successful engagement with psychiatric treatment among young patients experiencing first-onset psychosis. The results revealed the importance of the treatment setting and key relationships in achieving engagement. Service delivery implications include the need for a social relationship model between clinicians, patients, and their peers.

It's not that bad : the views of consumers and carers about routine outcome measurement in mental health

The mandatory use of routine outcome measurement (ROM) has been introduced into all public sector mental health services in Australia over the past 6 years. Qualitative processes were used to engage consumers and carers in suggesting how the measures can be used in clinical practice. The project involved an audit by survey, followed by a range of interactive workshops designed to elicit the views of consumers, carers and clinicians, as well as to involve all parties in dialogue about ROM. In addition, there was engagement of consumers and carers in the training of clinicians in the clinical use of ROM, and in the production of promotional materials aimed at informing consumers and carers about ROM. When consumers and carers have had an opportunity to be involved in ROM they have found it a useful experience, and those who had not been involved can see the potential. Consumers and carers indicated that they believe the greatest opportunity arising from the suite of measures is the use of the consumer self-assessment measure the Behaviour and Symptom Identification Scale (BASIS-32).

Experiences of engagement in occupations and assertive outreach services

Aim: The purpose of this study was to describe the experience and meaning of engagement for staff and clients of assertive outreach teams.
Method: Interpretative phenomenological analysis was selected for its flexibility and transparency. Data were collected by semi-structured interviews from a sample of five client and five staff participants (n = 10). The interviews were analysed idiographically, inductively and interrogatively.
Findings: Four themes identified by both staff and client participants emerged: engagement as an interpersonal relationship, engagement in and through time, enabling and disabling factors and engagement in occupation. In addition, clients developed a theme around engagement as a means to self-actualisation. Staff also raised a specific theme around the role of engagement in mental health services.
Conclusion: Staff and clients experienced engagement in broadly similar ways, but with differing emphases. Although all participants described it as both an invisible 'means' and a visible 'end', the staff related engagement only to mental health services whereas the clients experienced it in the context of both mental health services and occupations.
Relevance: This study is relevant to all occupational therapists who work with people experiencing mental health problems.

Evaluating discussion board engagement in the MoodSwings online self-help program for bipolar disorder: protocol for an observational prospective cohort study

BACKGROUND: Online, self-guided programs exist for a wide range of mental health conditions, including bipolar disorder, and discussion boards are often part of these interventions. The impact engagement with these discussion boards has on the psychosocial well-being of users is largely unknown. More specifically we need to clarify the influence of the type and level of engagement on outcomes. The primary aim of this exploratory study is to determine if there is a relationship between different types (active, passive or none) and levels (high, mid and low) of discussion board engagement and improvement in outcome measures from baseline to follow up, with a focus on self-reported social support, stigma, quality of life and levels of depression and mania. The secondary aim of this study is to identify any differences in demographic variables among discussion users.

METHODS/DESIGN: The present study is a sub-study of the MoodSwings 2.0 3-arm randomised controlled trial (discussion board only (arm 1), discussion board plus psychoeducation (arm 2), discussion board, psychoeducation plus cognitive behavioural therapy-based tools (arm 3)). Discussion engagement will be measured via online participant activity monitoring. Assessments include online self-report as well as blinded phone interviews at baseline, 3, 6, 9 and 12 months follow up.

DISCUSSION: The results of this study will help to inform future programs about whether or not discussion boards are a beneficial inclusion in online self-help interventions. It will also help to determine if motivating users to actively engage in online discussion is necessary, and if so, what level of engagement is optimal to produce the most benefit. Future programs may benefit through being able to identify those most likely to poorly engage, based on demographic variables, so motivational strategies can be targeted accordingly.