Showing papers in "Psychiatric Rehabilitation Journal in 2011"

Ending self-stigma: pilot evaluation of a new intervention to reduce internalized stigma among people with mental illnesses.

Abstract: Objective This study evaluated "Ending Self-Stigma" (ESS), a structured 9-session group intervention to help people with serious mental illnesses reduce internalized stigma. Methods Participants from two Veterans Administration mental health sites were assessed before and after the intervention regarding their levels of internalized stigma, empowerment, recovery orientation, perceived social support, and beliefs about societal stigma. Results Internalized stigma significantly decreased, and perceived social support and recovery orientation significantly increased. Conclusions and implications for practice "Ending Self-Stigma" is the first of its kind and may be a valuable intervention for reducing internalized stigma among people with serious mental illnesses, suitable for both professionally-delivered psychiatric rehabilitation programs and consumer-led programs and services.

Recovery-oriented service provision and clinical outcomes in assertive community treatment.

Abstract: OBJECTIVE While the term "recovery" is routinely referenced in clinical services and health policy, few studies have examined the relationship between recovery-oriented service provision and client outcomes. The present study was designed to examine the relationship between recovery-orientation of service provision for persons with severe mental illnesses and outcomes in Assertive Community Treatment (ACT). METHODS Client, family, staff, and manager ratings of service recovery-orientation and outcomes across a range of service utilization and community functioning indicators were examined among 67 ACT teams in Ontario, Canada. RESULTS Significant associations were found between ratings of recovery-oriented service provision and better outcomes in the domains of legal involvement, hospitalization days, education involvement, and employment. Results were not uniformly positive or consistent, however, across stakeholder Recovery Self-Assessment (RSA) ratings or outcomes. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These findings provide some preliminary support for an association between recovery-oriented service delivery for persons with severe mental illnesses and better outcomes. In line with the current practice commentary, this association would suggest the importance of evaluating and cultivating recovery-oriented values and practices in ACT contexts. This is a particularly salient point given that ACT standards minimally address key domains of recovery-oriented service provision. Further study is required, however, to determine if these findings apply to the implementation of ACT in other jurisdictions or generalize to other community support programs.

Effect of Wellness Recovery Action Plan (WRAP) participation on psychiatric symptoms, sense of hope, and recovery.

Abstract: Objective Self-management of psychiatric illness is a central tenet of consumer-directed mental health treatment. While several manualized self-management programs have been developed in recent years, the most widely disseminated is the Wellness Recovery Action Plan (WRAP). This study examined the effects of WRAP participation on psychiatric symptoms, hope, and recovery outcomes for people with severe and persistent mental illness. Methods A quasi-experimental study, with an experimental (n=58) and a comparison (n=56) group was conducted. WRAP sessions (8-12 week) were facilitated by one staff person and one peer worker at five community mental health centers in a Midwestern state. The Modified Colorado Symptom Index, the State Hope Scale, and the Recovery Markers Questionnaire (RMQ) were employed at the first and last WRAP sessions, as well as six months following the intervention. Repeated measures analysis of covariance and planned comparisons before and after the intervention were conducted. Results Findings revealed statistically significant group intervention effects for symptoms and hope, but not for RMQ. Planned comparisons showed statistically significant improvements for the experimental group in psychiatric symptoms and hope after the intervention, while non-significant changes occurred in the comparison group. Conclusions and implications for practice The study results offer promising evidence that WRAP participation has a positive effect on psychiatric symptoms and feelings of hopefulness. If recovery is the guiding vision for mental health system reform, the study results provide evidence that WRAP programming may warrant a place in the current array of services offered through the publicly funded mental health system.

Recovery-promoting professional competencies: perspectives of mental health consumers, consumer-providers and providers

Abstract: Objectives The purpose of this study was to empirically validate a set of conceptually derived recovery-promoting competencies from the perspectives of mental health consumers, consumer-providers and providers. Methods A national sample of 603 consumers, 153 consumer-providers and 239 providers completed an anonymous survey via the Internet. The survey evaluated respondents' perceptions about a set of 37 competencies hypothesized to enhance clients' hope and empowerment and inquired about interactions with providers that enhanced clients' recovery process. We used descriptive statistics and ranking to establish the relevance of each competency and generalized linear models and post-hoc tests to examine differences in the consumers', consumer-providers' and providers' assessments of these competencies. Results Analyses confirmed the recovery relevance of several competencies and their relative importance within each group of study participants. They also revealed that while most competencies tended to have universal significance, others depended more strongly on the client's preferences. Finally, differences in the perceptions of consumers, consumer-providers and providers about the recovery relevance of these competencies were established. Conclusions and implications for practice The study highlighted the crucial role practitioners play in enhancing recovery from serious mental illnesses through specific strategies and attitudes that acknowledge clients' personhood and foster their hopefulness, empowerment and illness management. It informed the development of a new instrument measuring providers' recovery-promoting competence and provides guidelines for sharpening the recovery focus of a wide range of mental health and rehabilitation services.

Wellness coaching: a new role for peers.

Abstract: TOPIC This brief report presents the conceptual framework for the development of the peer wellness coach role including the definition of a new job role for peer providers and an overview of the knowledge and skills required for this role. PURPOSE People with serious mental illnesses are at greater risk of living with untreated chronic medical conditions that severely impact their quality of life and result in premature mortality. Wellness coaching represents an intervention that can help individuals persist in the pursuit of individually chosen health and wellness goals. SOURCES USED Literature and our personal and professional experiences developing this role and training are presented. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Wellness coaching seems an ideal role for peers in recovery that has potential to address health and wellness issues facing persons living with mental illnesses who are at high risk of comorbid medical conditions.

Online peer support for individuals with depression: a summary of current research and future considerations.

Abstract: Topic Online peer support services are increasingly recognized as valuable resources for individuals living with depression to be proactively involved in the management of their mental health and well-being. Purpose The paper summarizes the research which has thus far explored the efficacy of online peer support services for people with depression and raises important questions for consideration of future research. Sources used Published literature on online peer support services for people with depression. Conclusions and implications Online peer support services can provide many advantages for people living with depression. However, given the limited empirical evidence of the efficacy of online peer support services specifically for depression, future research is required to substantiate the anecdotal evidence of these services. Obtaining a greater understanding of such services will facilitate the development of more effective and meaningful services to assist those living with depression.

Money management, mental health, and psychiatric disability: a recovery-oriented model for improving financial skills.

Abstract: Topic Although money management skills are essential for independent functioning in the community, when viewed from the framework of psychosocial rehabilitation, there have been few systematic models for teaching money management skills to consumers with psychiatric disabilities based on a recovery orientation. Purpose For those diagnosed with psychiatric disabilities, better money management has consistently been shown to be associated with superior quality of life, fewer hospitalizations, and greater self-efficacy. Consumers frequently indicate that learning how to budget and staying out of debt are among their top goals for recovery with mental illness. The current paper reviews the issues of money management and mental health among people with psychiatric disabilities and proposes a recovery-oriented approach to increasing money management skills to increase community functioning among consumers. Sources used Published literature, clinical cases, and financial literacy resources. Conclusions and implications for practice Improving money management can lead to a number of benefits by helping consumers with psychiatric disabilities: 1) gain more knowledge about disability benefits, 2) improve basic financial skills, and 3) reduce vulnerability to financial exploitation. Future work on incorporating this model into psychiatric rehabilitation programs would address skills consumers can use in living, working, and social environments in a way that enhances consumer choice and promotes recovery.

Healthy eating in persons with serious mental illnesses: understanding and barriers.

Abstract: Objective To explore the understanding of a healthy diet and the barriers to healthy eating in persons with serious mental illnesses. Methods In-depth semi-structured qualitative interviews about health behaviors were conducted in 31 individuals with serious mental illnesses. Participants were recruited from a mental health center in Chicago, Illinois, and ranged in age from 30 to 61 years old. Results Most participants described healthy eating as consuming fruits and vegetables, using low fat cooking methods, and limiting sweets, sodas, fast food, and/or junk food. Internal barriers to nutritional change included negative perceptions of healthy eating, the decreased taste and satiation of healthy foods, difficulty changing familiar eating habits, eating for comfort, and the prioritization of mental health. External barriers were the reduced availability and inconvenience of healthy foods, social pressures, and psychiatric medication side effects. Conclusions and implications for practice This study revealed several modifiable barriers to healthy eating. Interventions that addressed these could aid in improving the diet and lowering the risk of cardiovascular disease in this population. Recommendations are to provide healthy eating education that is individualized, emphasizes the health consequences of poor eating, and provides opportunities to prepare and taste healthy foods. Family and friends should be included in all educational efforts. At community mental health centers and group homes, only healthy foods should be offered. Lastly, practitioners should encourage eating a healthy diet, inquire about eating in response to emotions, and explore the impact of psychiatric medications on eating behaviors.

A place to be: The role of clubhouses in facilitating social support

Abstract: OBJECTIVE: Intentional recovery communities, such as clubhouse programs, aim to foster social connections among individuals at risk for isolation as a result of living with a serious mental illness to engage and become active participants in the community. The objective of the study was to gather information on the nature of clubhouse support as it pertains to social network support and social relationships. METHODS: The personal story/narrative approach was utilized and involved a naturalistic inquiry approach that allowed stories of clubhouse experiences to come forth with little interference or interjection as possible. RESULTS: Personal narratives revealed that staff, members and the overall clubhouse structure emerged as the center of social interaction and comfort for participants and a central sustaining means of social support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It appears that the clubhouse provides an intentional environment that creates a sense of community and a place to belong. The clubhouse as a place to be where one can meet individuals in like situations has been identified as very helpful in achieving recovery by providing the opportunity to rebuild one's shattered social network and offering contact with others in similar contexts.

Developing a quit smoking website that is usable by people with severe mental illnesses.

Abstract: Objective Evidence-based treatments may be delivered in computerized, web-based formats. This strategy can deliver the intervention consistently with minimal treatment provider time and cost. However, standard web sites may not be usable by people with severe mental illnesses who may experience cognitive deficits and low computer experience. This manuscript reports on the iterative development and usability testing of a website designed to educate and motivate adults with severe mental illnesses to engage in smoking cessation activities. Methods Three phases of semi-structured interviews were performed with participants after they used the program and combined with information from screen-recorded usability data. T-tests compared the differences between uses of the first computer program version and a later version. Results Iteratively conducted usability tests demonstrated an increased ease of use from the first to the last version of the website through significant improvement in the percentage of unproductive clicking along with fewer questions asked about how to use the program. The improvement in use of the website resulted from changes such as: integrating a mouse tutorial, increasing font sizes, and increasing button sizes. Conclusions and implications for practice The website usability recommendations provide some guidelines for interventionists developing web tools for people who experience serious psychiatric disabilities. In general, insights from the study highlight the need for thoughtful design and usability testing when creating a website for people with severe mental illness.

"You don't look like one of them": disclosure of mental illness in the workplace as an ongoing dilemma.

Abstract: Objective: The purpose of this study was to describe the pressures surrounding disclosure of a mental illness in the New Zealand workplace. Methods: Using qualitative methods and general inductive analysis, the study included twenty-two employed New Zealanders with experience of mental illnesses. Results: Fear of discrimination, and legal, practical and moral pressures contributed to tension between workplace disclosure and non-disclosure of a mental illness. Conclusions and Implications for Practice: The decision to disclose a mental illness is a dilemma throughout the employment process, not just a problem for the beginning of an employment relationship. Employees with experience of mental illnesses and their employers need to be able to access advice throughout this process on disclosure issues. Disclosure is irreversible; therefore, the decision to disclose, and its timing, must remain at the discretion of the employee. Language: en

Smoking cessation in persons with serious mental illnesses: the experience of successful quitters.

Abstract: OBJECTIVE The purpose of the study was to better understand the experiences of persons with serious mental illnesses who have quit smoking. METHODS Former smokers with serious mental illnesses who had been abstinent for at least 4 months participated in an individually-administered structured interview about their motivation to quit smoking and the strategies that they used to quit. Participants also were asked about their willingness to assist peers in smoking cessation. RESULTS The sample of 78 successful quitters had been abstinent from smoking for an average of 7.4 (±8.6) years after smoking for a mean of 25.3 (±11.4) years; the mean peak quantity of cigarettes smoked was 1.5 (± 1.1) packs per day. The primary reason for quitting smoking was health concerns, endorsed by 57 (73%) of respondents. Additional reasons included the cost of cigarettes (55, 71%); advice from a doctor (42, 54%); advice from others (50, 64%). The main methods that participants cited as enabling them to quit were social support from friends or family (cited by 45, 58%); direction from a doctor (36, 46%); use of nicotine replacement therapy (NRT) (24, 31%); and the advice of friends who had quit (18, 23%). Only a small proportion of the sample had received smoking cessation treatment other than NRT. A large portion of the sample indicated that they would be willing to serve in peer helping roles for smoking cessation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Persons with serious mental illnesses are able to successfully quit smoking despite extensive histories of heavy smoking. For practitioners, this study also emphasizes the importance of smoking cessation programming that is relevant and easily accessible to people with serious mental illnesses. Importantly, former smokers living with mental illnesses indicated a willingness to be involved in helping others quit, and should be utilized in formal smoking cessation efforts aimed at their peers.

A cross-sectional study of recovery training and staff attitudes in four community mental health centers.

Abstract: OBJECTIVE Recovery has become a concept often incorporated in mental health staff trainings. However, little research has investigated the influence of training on recovery attitudes. The current study examined whether recovery-related trainings in community mental health centers is associated with differences in staff attitudes and reported organizational practices. METHODS A total of 318 staff members at four community mental health centers completed questionnaires about their recovery attitudes and trainings they had received in the past year. RESULTS Compared to staff who had no recovery-related training in the past year, staff who had at least one recovery-related training reported significantly higher consumer optimism and a greater agency recovery orientation towards consumers' life goals. The number of recovery-related trainings was significantly correlated with scores on personal optimism, consumer optimism, and agency recovery orientation towards consumers' life goals. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The findings suggest recovery training is positively related to staff recovery attitudes and agency practices. Community mental health centers may benefit from a systematic approach to recovery training. Further research is needed to determine directionality of these relationships and to parse the mechanisms of action.

A qualitative study: barriers and facilitators to health care access for individuals with psychiatric disabilities.

Abstract: Objective This qualitative study was conducted as part of a larger randomized trial to examine barriers and facilitators to accessing and providing comprehensive primary health care for individuals with serious mental illnesses. We examined the perspectives of administrators and providers in a behavioral health organization surrounding the use of a nurse practitioner model of delivering primary healthcare. Methods Ten key informant interviews were conducted and analyzed using qualitative data analysis software. Concepts and themes regarding access to and delivery of primary healthcare were inductively derived from the data. Results Results confirmed significant issues related to chronic physical health problems among individuals with psychiatric disabilities and detailed a host of barriers to receiving health care as well as the perceived benefits of the nurse practitioner intervention. Financial challenges played a significant role in the organization's ability to make primary and mental health care integration a sustainable endeavor. In addition, staff faced increased burdens on their time due to adding a focus on physical health to their existing job duties. Conclusions and implications for practice A nurse practitioner stationed in a behavioral healthcare setting is viewed by administrators and providers as extremely beneficial in addressing issues of access to comprehensive and integrated primary healthcare for individuals with severe psychiatric disabilities but sustaining such a model of care is not without organizational challenges.

Dietary intake of adults with serious mental illness.

Abstract: OBJECTIVE Suboptimal diet may be related to the high prevalence of obesity and cardiovascular disease (CVD) in persons with serious mental illnesses, but few studies have characterized dietary intake in this population. METHODS Participants were 102 overweight/obese adults with serious mental illnesses who were being screened for a weight loss trial in psychiatric rehabilitation centers. Direct observation of participant meals was completed using a standardized measurement form. RESULTS CVD risk factors were common: mean body mass index was 35.7 kg/m2; 30% had diabetes. Participants consumed 100% of caloric beverages served (7.2 oz/meal) but consumption was significantly less than served for fruits (difference of 0.12 cups/meal, p=0.003) and vegetables (0.14 cups/meal, p=0.021). The majority (56%) of meat consumed was high fat. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Interventions designed to improve dietary intake of persons with serious mental illnesses are needed to improve health in this population at high risk for CVD.

Peer-delivered wellness recovery services: from evidence to widespread implementation.

Abstract: Reviewing the evidence for peer-delivered services, writing in 2004 in this journal, researcher Phyllis Solomon commented on the “high level of evidence” for peer-provided services, including four randomized studies and three quasi-experimental design studies using a variety of meaningful outcome measures (Solomon, 2004). The past two decades have witnessed a number of important studies of these models and services that meet these evidence criteria. For example, Paulson and his colleagues randomly assigned community mental health center clients to a peer-staffed Assertive Community Treatment (ACT)1 team, an ACT team staffed by non-peers, or services as usual (Clarke et al., 2000; Herinckx, Kinney, Clarke, & Paulson, 1997; Paulson et al. 1999). Results revealed no differences between the two ACT teams in participants’ symptom severity or any clinical or social outcome for the first two years of service delivery. However, both ACT teams had significantly greater treatment retention than usual care. In another study, clients of a community mental health center were randomly assigned to peerrun intensive case management (ICM) versus non-consumer-run ICM teams (Solomon & Draine, 1995a, 1995b). At two years, clients of both teams had equivalent symptoms, quality of life, and a variety of clinical and social outcomes. Service delivery patterns differed, however, in that the consumer case management team provided more face-to-face services and services outside of an office setting than did the non-consumer team.

Family contact and health status among older adults with serious mental illnesses.

Abstract: OBJECTIVES The purpose of this study was to explore the amount of family contact among older persons with serious mental illnesses (SMI), and to examine its relationship to health and mental health. METHODS An analysis of baseline data was conducted from a treatment study including 180 adults age 50 and older. The amount of family contact was examined with descriptive statistics. Differences in health and mental health were examined between participants with low, moderate, or high levels of family contact. Analyses also compared these groups on health and mental health functioning, controlling for psychiatric symptoms and the number and severity of medical diseases, respectively. RESULTS Over three-quarters of respondents (77.8%) reported speaking on the phone with a relative and two-thirds (67.2%) reported seeing a relative at least once during the past month. Older adults who lived with a family member had more severe mood symptoms and poorer mental health functioning. Those who lived with family or had moderate levels of family contact had more comorbid diseases and more disease severity than those with less family contact. These relationships remained significant after controlling for medical conditions or psychiatric symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The majority of older persons have regular family contact and those with the highest levels of family contact appear to have more compromised physical and mental health. Study findings provide new knowledge for practitioners regarding the importance of using family interventions to target physical health and mental illness management for older consumers who may need assistance to access medical care and treatment. Further research on the role of families in psychiatric and physical health management will provide a foundation for family interventions aimed at supporting community living among older adults.

Working plans of people with mental disorders employed in Italian social enterprises.

Abstract: OBJECTIVE Social Enterprises (SEn) are innovative companies that help disadvantaged people (e.g., individuals with mental disorders) with the work integration process. This study explores the working plan patterns of people with mental disorders employed in SEn. METHODS A cross-sectional design was adopted. One hundred and forty individuals with mental disorders employed in 19 Italian SEn filled out a battery of questionnaires. RESULTS We identified three patterns of working plans: Cluster 1 (n = 39, 30%) showed a stronger intention to work in a competitive labor market; Cluster 2 (n = 16, 12.3%) showed a stronger intention to stop working; Cluster 3 (n = 75, 57.7%) showed a stronger intention to continue working at a SEn. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Most of the sample had a pattern of intentions to keep working, thereby demonstrating the effectiveness of the SEn approach to work integration. Future studies should explore the approach further. Indeed, these results seem important for implications for practice, suggesting that people with mental disorders inside SEn can improve their level of interpersonal skills and reinforce their vocational identity, and ultimately increase their chances of employment in the regular labor market.

Sustaining recovery through the night: impact of a peer-run warm line.

Abstract: Objective This exploratory study describes the impact of a peer-run warm line on the lives of individuals with psychiatric disabilities. Methods Phone surveys were completed with 480 warm line callers over four years. Results Warm line callers reported a reduction in the use of crisis services and a reduction of feelings of isolation. Conclusions and implications for practice The results indicate that peer-run warm lines can fill an important void in the lives of individuals living with mental illnesses. Although warm lines at any time of day are helpful, keeping warm lines running after 5pm and throughout the night provides support services not typically available after office hours and can assist with loneliness, symptom management, and the process of recovery. Warm lines staffed with appropriately trained, clinically supervised, compensated peer specialists can help round out mental health services in rural and urban communities. Future research should focus on the various implementation and funding options of this unique peer support service.

Can employment positively affect the recovery of people with psychiatric disabilities

Abstract: Objective: This study explored the relationship between employment and recovery in individuals with psychiatric disabilities and proposed that participants who were employed would have higher levels of recovery than participants who were not employed. Methods: Data were analysed from a pre-existing data-set produced in a large scale NHMRC project conducted as part of the Australian Integrated Mental Health Initiative (AIMhi), High Support Stream. Participants were 344 people with a range of psychiatric illnesses who received support from 11 public sector and non-government mental health organizations in Queensland and New South Wales, Australia. Scores on the Recovery Assessment Scale (RAS) were compared between those participants who were engaged in paid employment and those who were not. Results: The results revealed that there was no difference in total recovery scores between those who worked and those who did not work. This finding indicated that higher recovery scores were not associated with participants who were employed. Also contrary to expectations, the results showed that workers scored lower than non-workers on the RAS factor described as "reliance on others" and there was a trend towards significance in the same direction on the factor "willingness to ask for help." Conclusions and Implications for Practice: Further research needs to be conducted to determine if the differences between workers and non-workers on the above factors represent a personal variable such as independence or self-determination that is associated with individuals with psychiatric disabilities that are engaged in employment. Rehabilitation interventions aimed at increasing levels of employment in people with psychiatric disabilities could improve recovery and employment outcomes through focusing on these personal variables. Copyright 2011 Trustees of Boston University.

Integrated primary and mental health care services: an evolving partnership model

Abstract: Topic Persons with serious psychiatric disabilities experience high rates of medical co-morbidities that, if properly treated, could improve overall well-being and the course of recovery. Purpose This brief reports describes how two organizations-Thresholds Psychiatric Rehabilitation Centers and University of Illinois College of Nursing-partnered to offer integrated behavioral and physical health care responsive to the needs of the population and committed to consumer-centered, holistic and preventative care. Most recently, the partnership offers primary care in different community settings through different service models-tele-monitoring, home visits, group visits. Sources used A combination of published literature, staff report, and quality assurance data informs this report. Conclusions and implications for practice The authors conclude that primary care outreach is a promising strategy in mental health settings and that the Chronic Care Model (CCM) provides a set of guidelines for designing and monitoring quality integrated care for a partnership model of integrated care.

Experiences and Motives Relative to Psychiatric Medication Choice

Abstract: Objective: The purpose of the present study was to investigate and describe from the participants’ perspectives the factors and processes influencing their choice as to whether to use prescribed psychiatric medication. Methods: Thematic content analysis of data was obtained from semi-structured interviews with 19 individuals diagnosed with mental illnesses. Results: Central themes related to using psychiatric medication were negative side effects, feeling like a “guinea pig,” stigma, and struggling with the decision to continue or not to continue to take medication. The consequences of this decision were also con sidered. Conclusions and Implications for Practice: Our findings support the notion that “non-adherence” related to psychiatric medication is not simply a “problem” but rather a complex issue requiring personalized attention. To further examine the potential usefulness of psychiatric medication, it is important that medication be perceived as personally relevant and that medication issues be discussed within the context of an ongoing authentic dialogue between med ica tion prescriber and user.

Building human capital to increase earning power among people living with mental illnesses.

Abstract: Objective Human Capital Theory, a well-established model from the field of economics, maintains that a person's lifetime earnings are affected by the amount of education and job training they receive. This study uses Human Capital Theory to predict wages and explain employment outcomes among individuals living with psychiatric illnesses. Methods Hourly wages were examined between 100 individuals with mental illnesses and 100 matched comparisons who had no mental illnesses. Results The study found that participants with mental illnesses earned $12.19 an hour vs. $14.54 an hour earned by their counterparts without disability. The study also revealed that higher educational attainment and longer work history predicted higher wages among participants with mental illnesses. The severity of psychiatric symptoms and diagnosis, however, did not predict wages. Conclusion and implications for practice These findings indicate that human capital variables are correlated with wages earned by persons living with mental illnesses. Findings also suggest that assisting mental health consumers in the pursuit of education and job training may increase earning potential which can lead to financial independence and community integration. This supports the value in developing and implementing Supported Education to assist consumers in acquiring education and job training.

An examination of time-use among adults diagnosed with severe mental illnesses using daily interviews.

Abstract: OBJECTIVE The authors examined clinical, demographic and programmatic predictors of average time-use during weekdays and weekends. METHODS Mental health consumers (N = 22) participating in day treatment (DT) and assertive community treatment (ACT) programs first completed measures of symptoms and substance use, and then completed daily interviews on time-use for up to 20 days. RESULTS Consumers who were participating in DT, as opposed to ACT, spent more weekday time in productive activity, but only when treatment was considered productive activity. DT participants also reported more weekend productive time-use. Clinical and demographic variables did not predict productive time-use, with the exception of negative symptoms (which predicted less) and African-American ethnicity (which predicted more). CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings are consistent with previous studies indicating that many mental health consumers spend considerable amounts of time involved in sleep and passive leisure. However, structural factors, rather than symptoms, may be the greatest determinants of productive time-use. Rehabilitation interventions may need to be tailored to increase such opportunities for productive time-use.

Consumer-Operated Service Programs: Monetary and Donated Costs and Cost-Effectiveness

Abstract: OBJECTIVE Examine cost differences between Consumer Operated Service Programs (COSPs) as possibly determined by a) size of program, b) use of volunteers and other donated resources, c) cost-of-living differences between program locales, d) COSP model applied, and e) delivery system used to implement the COSP model. METHODS As part of a larger evaluation of COSP, data on operating costs, enrollments, and mobilization of donated resources were collected for eight programs representing three COSP models (drop-in centers, mutual support, and education/advocacy training). Because the 8 programs were operated in geographically diverse areas of the US, costs were examined with and without adjustment for differences in local cost of living. Because some COSPs use volunteers and other donated resources, costs were measured with and without these resources being monetized. Scale of operation also was considered as a mediating variable for differences in program costs. RESULTS Cost per visit, cost per consumer per quarter, and total program cost were calculated separately for funds spent and for resources donated for each COSP. Differences between COSPs in cost per consumer and cost per visit seem better explained by economies of scale and delivery system used than by cost-of-living differences between program locations or COSP model. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Given others' findings that different COSP models produce little variation in service effectiveness, minimize service costs by maximizing scale of operation while using a delivery system that allows staff and facilities resources to be increased or decreased quickly to match number of consumers seeking services.

Promoting staff wellness.

Abstract: training,” promoting staff wellness is an important component in hiring, supervising, and evaluating psychiatric rehabilitation practitioners. Certainly, a “well” staff member is likely to have reduced absenteeism, but also is likely to be a more efficient worker and a more effective learner. Given the emphasis on wellness in psychiatric rehabilitation today, spurred on by the fact that people with a major mental illness have dramatically shortened life spans, a “well” workforce also provides a model of health for people using services and will be informed about wellness strategies from personal experience.

Paxton house: integrating mental health and diabetes care for people with serious mental illnesses in a residential setting.

Abstract: Objective This report provides a program description of a supported housing residence for individuals with co-occurring diabetes and serious mental illnesses and preliminary health outcome data. Methods Weight, blood glucose levels and satisfaction survey data were collected retrospectively on 13 individuals referred to the program. Results Results indicate that individuals lost weight and fasting glucose readings fell into the ADA recommended range in the first six months of participation. Overall, consumers participating in the program were satisfied with the diabetes education and monitoring services provided. Conclusions and implications for practice While preliminary results suggest that consumers benefit, this study only begins to address how integrated behavioral health and diabetes-specific programming in residential settings meets the needs of persons with severe mental illnesses and diabetes. A more thorough understanding of the impact of these programs on consumers' health outcomes is needed to inform how to deliver diabetes management curricula and support consumers to improve their overall health.

Pathways to translating experiential knowledge into mental health policy.

Abstract: Objective This research explored the pathways through which the experiential knowledge of people who need and use mental health and social housing services (citizen-users) gains access to policymaking. Methods Qualitative instrumental case study methodology focused the study on the policy field of mental health and social housing in Manitoba, Canada. Data collection included interviews with 21 key informants from four policy actor groups: citizen-users, service providers, advocacy organization representatives, and government officials. Relevant policy-related documents were also reviewed. Data were analyzed using inductive qualitative methods. Results Key informants described diverse pathways through which the experiential knowledge of citizen-users has been communicated to policy decision makers. Pathways have involved direct discourse between citizen-users and decision makers. Alternatively, indirect pathways were ones in which experiential knowledge was translated by other policy actors. Informants identified factors that could influence the integrity of the indirect pathways: the length and complexity of the pathways, the motivations and interests of the translators, and strategies to enhance the pathways. The pathways could be strengthened by developing the culture, leadership, knowledge, skills and attitudes supportive of engaging citizen-users and by accurately translating their experiential knowledge. Conclusions and implications for practice If citizen-users are to be included in policymaking in a recovery-oriented mental health system, action must be taken to enhance the pathways through which their experiential knowledge reaches policymaking processes. Service providers, advocacy organization representatives and government officials can all take action to promote social policymaking that is informed by citizen-users' ideas and experiences.

The recovery education center: an integrated health promotion and wellness program.

Abstract: TOPIC This brief report describes a recovery education program that is designed to develop health as a foundation for recovery from psychiatric illnesses. PURPOSE Using readiness to change theory, health promotion, and psychiatric rehabilitation processes that are bundled in an adult education model of service, participants learn the knowledge, skills, and supports they want and need to increase their domains of wellness that will support their recovery. SOURCES USED Author's relevant knowledge and citations of health and behavioral health evidence. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Health promotion that is delivered in a healthy environment enhances people's quality of life, promotes readiness for role change and in the end, works to ensure that people with mental illnesses have a right to optimal health. To support rehabilitation and recovery, practitioners are encouraged to review this program model and select elements described to replicate in various mental health settings.