出院精神病患者的职业康复

精神病患者出院后的职业康复研究是目前西方精神疾病康复研究的热点。通过帮助出院后症状稳定的精神病患者就业,来帮助患者获得技能,获取收入,增强自信和自我认同,提升生活质量,较好地回归社会。文章从总体上介绍了职业康复的研究现状与进展,并着重阐述了较新的支持性就业、个体支持性就业、工作社交技能训练和综合性支持性就业等方法,旨在为我国的相关研究提供参考     

Service User Perception of and Satisfaction with Programs Having Higher Education and Employment Goals for People Diagnosed with Mental Illness

This study examined quantitative and qualitative outcomes of service users’ perceptions of and satisfaction with a program having higher education and employment goals. In a one-group post-test design, 48 participants with various mental health diagnoses completed a quantitative questionnaire and 29 of those participated in qualitative focus groups. Participants identified positive and negative aspects of the program and provided recommendations for change. Results indicated that service users with higher education and employment goals benefit from a multi-faceted program that includes person-centered individualized care, concrete, goal-directed activities, practitioners who are compassionate and knowledgeable, and plans addressing setbacks and obstacles.     

Stress Reduction for Family Caregivers in Chronic Mental Illness: Implications of a Work Stress Management Perspective

In several studies involving a total of 291 family caregivers for schizophrenia sufferers, the stressors that arise from caregiving were identified. Also identified were the outcomes for caregivers, which often include psychological distress. Caregivers develop various stress-reduction techniques, but this article explores the utility of applying the principles of work stress management to caregiver well-being. An organizational psychology perspective suggests that a comprehensive focus must include not only how individuals can learn to manage the emotional demands of their work, but also how the work of caregiving can be made less stressful for them. Suggestions from a work stress management perspective highlight the possible contributions of worker participation in policy formulation and a collaborative relationship between family and professional caregivers. Potentially fruitful research directions are noted.     

Sensory Modulation for People with Anxiety in a Community Mental Health Setting

Anxiety is a common mental health issue involving cognitive and physiological hypersensitivity to threat. It negatively affects occupational participation. Sensory modulation intervention aims to use calming sensory input to manage the hypersensitivity and physiological arousal associated with anxiety. The empirical evidence for using sensory interventions for anxiety, however, is limited. This mixed methods single subject case design explored the effectiveness of a 6-week sensory modulation intervention for reducing anxiety and improving occupational participation. Results showed significant reduction in anxiety and improved participation, providing further evidence that sensory modulation is an effective approach for the self-management of anxiety.     

A Cost Analysis of Self-Management Programs for People with Chronic Illness

The soaring cost of health care is a national problem that needs response at multiple levels, including that of the community. Reducing or limiting health care costs through interventions that emphasize the self-management of health may promote broader health care coverage, better quality of health care, and a sense of control over one's health. Therefore, it behooves community psychologists to perform cost analyses when testing interventions for people in a community. The present study investigated the effects of social support and education interventions on psychosocial variables, health status, and health care costs in older people with osteoarthritis. Participants were 363 members of a health maintenance organization (HMO), 60 years of age and older, with osteoarthritis. Participants were randomly assigned to one of three intervention groups (social support, education, or a combination of both) or to a control group. The results indicated that feelings of helplessness decreased in the intervention groups but not in the control group. All groups showed increases in self-efficacy and overall health status. In addition, health care costs increased less in the intervention groups than in the control group. Cost analysis was used to demonstrate that the monetary savings of the intervention greatly outweighed the cost of conducting the intervention. It appears that interventions can limit health care costs while improving health and increasing feelings of control for older people with osteoarthritis. Further, this paper demonstrates how a cost-benefit focus can benefit community studies.     

Personality Disorders in Older Adult Inpatients with Chronic Mental Illness

It has been hypothesized that some types of personality disorders tend to remit with age whereas others may become more prominent. The present study determined the prevalence and nature of 13 personality disorders with a self-report inventory (Coolidge Axis II Inventory) in an older group of chronically mentally ill inpatients (N = 30, mean age = 63 years) and a younger group of similar patients (N = 30, mean age = 39 years). All patients met DSM-IV criteria for either Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, or recurrent severe Major Depression with psychotic features. The prevalence rate of personality disorders was high for both groups: 58% for the older sample and 66% for the younger group. The younger group was more likely to be diagnosed Antisocial, Borderline, Passive-Aggressive, Sadistic, and Schizotypal, but the groups were not different in the rates of Obsessive-Compulsive Disorder. This study supports the hypothesis that some personality disorders remit with age. However, no evidence was found to suggest that other personality disorders become more prominent in older adult psychiatric populations. Suggestions for future research are offered.     

The Effects of Introducing Peer Support to Young People with a Chronic Illness

Peer support groups have been an increasingly popular way of limiting the adverse effects of life with a chronic illness for adolescents although few groups have been rigorously evaluated. This paper reports the findings of a realistic evaluation of a hospital based peer support program Chronic Illness Peer Support (ChIPS), in Sydney, Australia. We collected qualitative interview and focus group data from four participant groups; new ChIPS members, their parents, older members who had been in ChIPS for two or more years, and ChIPS co-ordinators past and present. Results of qualitative data have been aggregated and organised into three categories; program attendance: getting in and staying in; program outcomes for young people: personal growth and development; and social connection. Questionnaires were also administered to fourteen new ChIPS members but no significant changes in distress or self-esteem were recorded between the beginning and the end of the short study period. The ChIPS Introductory Program fulfilled its aim, entering young people with chronic illness into the peer support program. There was evidence of initial personal growth and development in those young people, with potential for enhanced social connection from ongoing participation in ChIPS activities.     

Trauma‐Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma‐informed. While community mental health and other human services settings are moving toward trauma‐informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle‐driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second‐order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.     

Housing for People with Serious Mental Illness: A Comparison of Values and Research

This article contrasts values associated with the delivery of housing programs for people with serious mental illness with the typical topics pertaining to housing that are studied by researchers. Six values were identified through a search and content analysis of the literature on housing for people with serious mental illness. A second review of the literature was conducted to identify research on housing for this population. A comparison of findings from the two reviews suggested that whereas values concerned with the therapeutic benefits of housing had received considerable research attention, those concerned with a citizenship dimension had received relatively little. The findings are discussed in terms of their implications for the delivery of housing services and for housing research.     

Profiles of Chronic Illness Knowledge in a Community Sample of American Adults

The author identified profiles of chronic illness knowledge (i.e., heart disease, cancer, diabetes) in a community sample of American adults and examined the effect of sociodemographic influences on relations of illness knowledge to health practices and well-being. Participants were 181 women and 120 men who completed measures of illness knowledge, sociodemographics, personal health practices (e.g., diet, exercise, substance abuse, adaptive healthcare use), well-being (e.g., self-rated physical health, depression, social support), and perceived illness risk. Two-step cluster analyses performed on random subsets of the sample identified three levels of illness knowledge: low, medium, and high. Knowledge groups were differentiated on most measures of health practices, well-being and perceived illness risk. However, effects were substantially attenuated after controlling for differences in age and SES. Findings indicate that age and other sociodemographic factors are related not only to levels of illness knowledge but also to the application of knowledge in relation to health practices and well-being.     

Addressing the Challenge of Community Reentry Among Released Inmates with Serious Mental Illness

The purpose of the paper is to discuss the formidable challenges to community reentry and reintegration faced by U.S. prison inmates with serious mental illness and to describe various strategies for improving transitional services for these individuals. We review epidemiologic data supporting the high prevalence of severe mental illness in U.S. prisons as well as the historical factors underlying the criminalization of the mentally ill. The importance and challenges of providing adequate psychiatric care for mentally ill prisoners during their incarceration are discussed. We also review the numerous psychosocial and economic challenges confronting these individuals upon their release from prison, such as unemployment and vulnerability to homelessness, as well as specific barriers they may encounter in attempting to access community-based mental health services. We follow with a discussion of some of the more promising strategies for improving the transition of the mentally ill from prison to the community. In the final sections, we review the evidence for a relationship between serious mental illness and recidivism and briefly discuss emerging alternatives to incarceration of the mentally ill.     

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.     

The Perspectives of Young People of Parents with a Mental Illness Regarding Preferred Interventions and Supports

Young people of parents with a mental illness are at significant risk of developing a mental illness. This risk may be reduced if appropriate interventions are provided. While there are several supports available, their needs are rarely heard in either intervention development or evaluation. This study presents young people’s perspectives of the types of supports they want. One hundred and seventy-two young people (13–17 years) whose parent has a mental illness completed a self-constructed questionnaire and six of these participants engaged in individual follow-up interviews. Frequency data indicated that youth want to learn how to cope or manage their parent’s mental illness and highlighted a need to access support online. Interview thematic analysis reflected a need for psycho-education, confidential and/or anonymous support, and a preference to access information from health care professionals. Given the diversity of views presented, this study suggests that “not one size fits all”.     

Stigma by Association Among Family Members of People with a Mental Illness: A Qualitative Analysis

People with mental illness are not the sole recipients of stigmatisation; their immediate family members may be subjected to stigma by association. Through semi‐structured interviews, we investigated experiences of stigma by association among 23 immediate family members of people with mental illness. Participants reported experiencing stigma by association from community members, mental health professionals, and civil servants. Familial relationship, co‐residence, and the gender of participants appeared to play a role in their stigma experiences; parents and spouses reported different manifestations of stigma by association than siblings and children, participants who lived together with their family member with mental illness reported increased experiences of stigma by association, and in contrast to male participants, female participants reported others thinking they are overprotective and as such perpetuated, maintained, or sustained their family members' mental illness. The relevance of these factors points to the need for tailored education and emotional support provision to family members of people with mental illness. Moreover, in‐service training for mental health professionals should include the development of relevant social skills that enable the recognition of familial relationships and roles, and family members' fears, concerns, and problems. Copyright © 2014 John Wiley & Sons, Ltd.     

Exercise and Movement as an Adjunct to Group Therapy for Women with Chronic Mental Illness

Abstract

Feminist therapists value the empowerment of clients and the appropriate sharing of the therapist's institutionalized power. As therapists who are also “mandated reporters,” we are obligated under certain circumstances to use our power to warn potential victims of harm, to prevent clients from harm to self or others, or make reports to institutions which have a great impact on clients' lives. Using four case examples, this paper will present clinical situations where the use of the therapist's power interfaces with homophobia, racism, and paternalism in the lives of low-income clients.     

Community Participation of People with Mental Health Issues within an Urban Environment

Photovoice is an action research methodology in which people create/share photographs with stakeholders to generate personal and community change. In this study, people with mental health issues used photovoice to explore questions about community participation within an urban environment. Identified areas of occupation include spending time with friends, daily living tasks, and managing symptoms. Facilitators to community participation include access to supports, transportation, and making friends. Factors limiting participation include the risks for stigmatization, homelessness, and medication side effects. Implications for occupational therapy intervention include supporting participants’ community participation by developing friendships/supports and addressing the ongoing demands of symptom management.     

Perceived Stress and Comorbid Illness Predict Depressive Symptomatology in People with Coeliac Disease

A high prevalence of depression is found in people with coeliac disease (CD). People with CD who are depressed are less likely to manage their illness effectively, which may lead to complications. Identification of variables associated with depression in people with CD may facilitate early detection and intervention. Participants were 749 members (125 males, 622 females) of the Queensland Coeliac Society (aged 18–88 years), recruited via a mailout. Participants completed the Modified Zung Self‐Rating Depression Scale, the Perceived Stress Scale, and the Perceived Consequences Subscale (from the Revised Illness Perception Questionnaire). Stress (p = .001) and comorbid medical illness (p = .01) were significantly associated with depression in CD. The current study made an original contribution to the body of literature by identifying stress and comorbid medical illness as predictors of depression in CD.     

Childhood Abuse,Head Injuries,and Use of Medical Emergency Services in People with Severe Mental Illness

People with severe mental illness (SMI) report high rates of traumatic experiences. This study analyzes data collected from 183 people diagnosed with SMI on reports of childhood trauma, head injuries, and emergency room (ER) services. More than half the cohort (56.7%) reported 3 to 7 cooccurring categories of childhood abuse (CAB). People who reported 6 and 7 categories of CAB had a 5-fold risk of experiencing a head injury. If they have used the ER for reasons other than psychiatric illness they endorse more traumatic experiences in their childhood when compared to those who did not. People with SMI and cooccurring CAB experiences might be predisposed to a higher risk of head injuries and more frequent use of the ER.     

Pilot Effectiveness of a Stress Management Program for Sheltered Homeless Adults With Mental Illness: A Two-Group Controlled Study

This study examined the effectiveness of a stress management intervention for sheltered homeless adults with mental illness. Twelve intervention participants received a 6-week, 1-hour psychoeducation group combined with a 20-minute meditation. Eleven matched pairs did not receive intervention and served as controls. At 1 week post study, intervention participants reported a statistically significant reduction in perceived stress (Z=??2.285, p < .02, d=??1.176) compared to controls. No differences were found at 1 week post study between intervention and control participants on reported quality of life. This study provides pilot data on the effectiveness of an occupation-based stress management program for sheltered homeless adults and warrants further study.     

Exploring the Experiences of Individuals With Serious Mental Illness in a Modified Treatment Mall: Centralized Off-Unit Programing With Extended Hours,a Mixed Methods Study

Abstract

Centralized Off-Unit Programing With Extended hours (COPE) is a recovery-oriented model of service that aims to address limited occupational engagement and social isolation among inpatient clients with serious mental illness. This study explored the self-reported outcomes of 12 clients using semi-structured interviews and pre- and post- administration of the Personal Recovery Outcome Measure. These outcomes were supported by significant improvements in personal recovery and included sense of choice, occupational engagement, socialization, change in environment, skill learning, and improved sense of wellness. These findings provide preliminary evidence on the COPE model of service and its potential role in promoting personal recovery.