Providing a ‘whole-of-family’ approach to care: family-focused practices in mental health services

Introduction: Family members including children are all impacted by a family member’s mental illness. Although mental health services are increasingly encouraged to engage in family-focused practice, this is not a well-understood concept or practice in mental health care. Methods: An integrative review using systematic methods was conducted with international literature, with the aim of identifying concepts and practices of family-focused practice in child and youth and adult mental health services. Results: Findings from 40 peer-reviewed literature identified a range of understandings and applications of family-focused practice, including who comprises the ‘family’, whether the focus is family of origin or family of procreation or choice, and whether the context of practice is child and youth or adult. ‘Family’ as defined by its members forms the foundation for practice that aims to provide a whole-of-family approach to care. Six core practices comprise a family focus to care: assessment; psychoeducation; family care planning and goal-setting; liaison between families and services; instrumental, emotional and social support; and a coordinated system of care between families and services. Conclusion: By incorporating key principles and the core family-focused practices into their care delivery, clinicians can facilitate a whole-of-family approach to care and strengthen family members’ wellbeing and resilience, and their individual and collective health outcomes.

Psychiatric Nurses’ Practice with Parents who have Mental Illness, their Children and Families, within Adult Mental Health Services in Ireland

Introduction: While it is recommended that mental health professionals engage in family focused practice (FFP), there is limited understanding regarding psychiatric nurses’ practice with parents who have mental illness, their children and families in adult mental health services.

Methods: This study utilized a mixed methods approach to measure the extent of psychiatric nurses’ family focused practice and factors that predicted it. It also sought to explore the nature and scope of high scoring psychiatric nurses’ FFP and factors that affected their capacity to engage in FFP. Three hundred and forty three psychiatric nurses in 12 mental health services throughout Ireland completed the Family Focused Mental Health Practice Questionnaire (FFMHPQ). Fourteen nurses who achieved high scores on the FFMHPQ also participated in semi-structured interviews.

Results: Whilst the majority of nurses were not family focused a substantial minority were. High scoring nurses’ practice was complex and multifaceted, comprising various family focused activities, principles and processes. Nurses’ capacity to engage in FFP was determined by their knowledge and skills, working in community settings and own parenting experience.

A Letter of Consequence: Referral Letters from General Practitioners to Secondary Mental Health Services

The referral letter is a key instrument in moving patients from primary to secondary care services. Consequently, the circumstances in which a referral should be made and its contents have been the subject of clinical guidelines. This article is based on a project that demonstrated that physicians do not adhere to clinical guidelines when referring patients to secondary mental health services. This research supports earlier findings into noncompliance with guidelines by general practitioners (GPs). The authors briefly note possible reasons, which have been the subject of some debate. They also present a content analysis of referral letters to demonstrate the important ways in which they differ from guideline criteria. However, their central argument is that the role of the referral letter in relation to the GP’s repertoire of treatments has not been understood fully. Such understanding implies the need for a reexamination of the support available for GPs.

People with psychiatric disabilities, employment, and the Americans with Disabilities Act : turning policy into practice : report from the Center for Mental Health Services ADA Roundtable, January 25-26, 1995 /

"The report ... summarizes the major points of discussion at the meeting as well as integrating other pertinent information"--P. iii.

"Music therapy helped me get back doing": perspectives of music therapy participants in mental health services

BACKGROUND: Mental health service development internationally is increasingly informed by the collaborative ethos of recovery. Service user evaluation of experiences within music therapy programs allows new phenomena about participation in services to be revealed that might otherwise remain unnoticed. OBJECTIVE: The aim of this study was to demonstrate how asking service users about their experience of music therapy can generate useful information, and to reflect upon the feedback elicited from such processes in order to gain a deeper understanding of how music therapy is received among service users in mental health. METHODS: Six mental health service users described their experiences of music therapy in one or two individual interviews. Transcripts of interviews were analyzed using the procedures and techniques of Interpretative Phenomenological Analysis. RESULTS: Interviews with mental health service users provided rich, in-depth accounts reflecting the complex nature of music therapy participation. Super-ordinate themes refer to the context in which music therapy was offered, the rich sound world of music in music therapy, the humanity of music therapy, and the strengths enhancing opportunities experienced by service users. CONCLUSIONS: Participants indicated that they each experienced music therapy in unique ways. Opinions about the value of music therapy were revealed through an interview process in which the researcher holds an open attitude, welcoming all narrative contributions respectfully. These findings can remind practitioners of the importance of closely tuning into the perspectives and understandings of those who have valuable expertise to share about their experience of music therapy services in mental health.

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.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Assessing cost-effectiveness in mental health: helping policy-makers prioritize and plan health services

Objective: We assessed, from a health sector perspective, options for change that could improve the efficiency of Australia's current mental health services by directing available resources toward 'best practice' cost-effective services.

Method: We summarize cost-effectiveness results of a range of interventions for depression, schizophrenia, attention deficit hyperactivity disorder and anxiety disorders that have been presented in previous papers in this journal. Recommendations for change are formulated after taking into account 'second-filter criteria' of equity, feasibility of implementing change, acceptability to stakeholders and the strength of the evidence. In addition, we estimate the impact on total expenditure if the recommended mental health interventions for depression and schizophrenia are to be implemented in Australia.

Results: There are cost-effective treatment options for mental disorders that are currently underutilized (e.g. cognitive–behavioural therapy (CBT) for depression and anxiety, bibliotherapy for depression, family interventions for schizophrenia and clozapine for the worst course of schizophrenia). There are also less cost-effective treatments in current practice (e.g. widespread use of olanzapine and risperidone in the treatment of established schizophrenia and, within those atypicals, a preference for olanzapine over risperidone). Feasibility of funding mechanisms and training of staff are the main second-filter issues for CBT and family interventions. Acceptability to various stakeholders is the main barrier to implementation of more cost-effective drug treatment regimens. More efficient drug intervention options identified for schizophrenia would cost A$68 million less than current practice. These savings would more than cover the estimated A$36M annual cost of delivering family interventions to the 51% of people with schizophrenia whom we estimated to be eligible and this would lead to an estimated 12% improvement in their health status. Implementing recommended strategies for depression would cost A$121M annually for the 24% of people with depression who seek care currently, but do not receive an evidence-based treatment.

Conclusions: Despite considerable methodological problems, a range of cost-effective and less cost-effective interventions for major mental disorders can be discerned. The biggest hurdle to implementation of more efficient mental health services is that this change would require reallocation of funds between interventions, between disorders and between service providers with different funding mechanisms.

A survey of occupational therapists providing services under the Better Access to Mental Health initiative

The Australian government launched the Better Access to Mental Health initiative in 2006, to help more people access psychological therapies. Occupational therapists can register to offer these services, and this survey aimed to investigate their participation within the first 12 months of operation.
Two surveys were conducted with occupational therapists registered to offer Better Access to Mental Health services, at the six and twelve month mark of the initiative. These surveys collected both quantitative and qualitative data. While the demographic profile of occupational therapists remained stable across the surveys, the client population varied over time. Depression and anxiety were the most common conditions treated under this scheme. Occupational therapists reported generally positive attitudes towards the initiative, and did not identify any pressing training needs. However, the current rebate for services was a source of dissatisfaction for many respondents.
This survey has established a baseline for further investigation in this area. The provision and outcomes of this particular initiative needs to be a priority for future research to secure occupational therapy's place in this developing area of practice, thereby providing consumers with greater choice and access to intervention at a primary health level.

A guide for providers of mental health and addictive disorder services in managed care contracting /

Shipping list no.: 99-0117-P.

Estimating and managing risks for the utilization and cost of mental health and substance abuse services in a managed care environment /

Shipping list no.: 98-0349-P.

Programs and services of the Area D Community Mental Health Center.

On cover: The Area D Community Mental Health Center; programs and services, 1971.