Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

Implementation in a Changing Landscape: Provider Experiences During Rapid Scaling of Use of Evidence-Based Treatments

This study examined 133 service providers’ perspectives on a rapid shift to mandated evidence-based treatment delivery, utilizing an inductive coding process to capture themes present in their qualitative feedback. The majority of provider comments were negatively valenced, but attitudes varied considerably across response categories: comments regarding practice context and support were nearly uniformly negative, while comments regarding treatment fit and therapeutic consequences were more balanced. Treatment fit was the most commonly cited category; the fit to therapist (e.g., ease of use) subcategory was predominantly positive in contrast with the fit to client (e.g., flexibility) subcategory, which was predominantly negative. Results illustrate the intended and unintended consequences of large-scale implementation efforts on community providers, and may aid implementation researchers and system decision makers optimize the conditions under which community providers are asked to implement evidence-based treatment.     

国外心理健康服务及其启示

在回顾了美国、瑞典等国家心理健康服务概况的基础上提出了以下启示：1．中国心理健康服务体系应以构建和谐社会理论为基础;2．在心理服务的教育与培训中,应当尽量兼顾普及知识与提高专业化水平两个目标;3．政府应当大力支持社区心理健康服务以及包含各种社区可用资源的综合性社区服务;4．中国心理健康服务必须从本国文化与国情出发,因此还需要更多这方面的文献总结与实际诃查工作;5．心理健康服务应当全面而有区别地实施予心理健康水平不同的人群。     

Community Psychology and Community Mental Health: A Call for Reengagement

Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross‐cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under‐examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health.     

Community Mental Health in Emergencies and Mass Disasters

Summary

Mass disasters are widespread and intensive, affecting individuals, families, communities, society, and culture. Mental health services must play a crucial role in order to meet non-routine challenges that put basic professional issues to the test both in theory and in practice. In the Tel Aviv Model, responsible planning is based on a broad system of mediators and activities during normal times, supplemented by intervention personnel and techniques set in motion during emergencies. This operation is coordinated with municipal and governmental support systems, which must be aware of the importance of comprehensive and flexible emergency systems for treating the population.     

Digital Mental Health Services: Moving From Promise to Results

The papers in this special series make a compelling case for the value of digital mental health services (DMHS; including technology-based interventions, assessments, and prevention programs) to help address some of the currently unmet needs in mental health care. At the same time, the papers highlight the work that needs to be accomplished for DMHS to fulfill their promise. We review the papers’ contributions in terms of (a) the imperative to increase access to evidence-informed, high-quality care, especially for underserved populations, both in the United States and globally; (b) ways to use DMHS to improve the ways that clinical care is provided to make treatment provision more effective and efficient; and (c) the current state of the research on DMHS for emotional disorders. We then consider lessons learned and recommendations to move the field forward, such as increasing (and making transparent) the research base on DMHS, adopting regulatory standards for DMHS, attending carefully to training issues for DMHS and best practices for dissemination and implementation, designing specifically for digital platforms, and being intentional about efforts to reduce disparities regarding who benefits from DMHS.     

诠释与转换：积极心理健康及其当代理解

积极心理健康是积极心理学理论系统的一个重要组成部分,也是积极心理学理论本身在心理健康领域的一种应用。积极心理健康以积极为核心观念,以人的积极品质为研究对象,注重人的个体差异的研究思路,引领和推动传统心理健康从关注人的消极品质转向人的积极潜力,从而使心理健康的主题既符合时代潮流又具有深厚的思想底蕴。     

Reaching Out: Improving the Continuity of Care of Community Mental Health Services Through a Weekly Climbing Group

This mixed-method study examined the impact of a novel activity group on engagement in care. Thirty-two participants were recruited from National Health Service (NHS) community mental health services in three inner-London boroughs. Participants undertook eight weekly sessions of supervised climbing. There was a significant quantitative improvement in the domain “individual progress” (Z = 2.12, p = 0.03). Qualitative data indicated a wide range of benefits. The study identified both direct and indirect benefits to continuity of care. The study validates the use of a climbing activity group to engage and benefit community mental health service users.     

Broadening Mental Health Services to Disadvantaged Communities in South Africa: Reflections on Establishing a Community Based Internship

The need to provide mental health services in disadvantaged communities remains a priority in South Africa. This paper illustrates how in consultation and partnership with the peri-urban community of Jamestown, a counselling psychology internship was established to provide a range of mental health services at a primary health clinic. We describe how the internship also became an important catalyst for other community interventions. We also illustrate how values of community psychology informed the establishment and foci of the internship. Tensions encountered in reconciling community needs and professional training requirements discussed include the lack of resources at the primary health care level, the bio-medical bias of the primary health setting, and addressing the needs articulated by the community for more direct interventions.     

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.     

Parent-School and Community Partnerships in Children's Mental Health: Networking Challenges, Dilemmas, and Solutions

Inter-agency collaboration, service coordination, and the creation of successful partnerships among parents, teachers, and human services professionals continues to be a challenge for the development of responsive community-based systems of care for at-risk youth and their families. We explore how one inner-city neighborhood struggles to create successful community partnerships through traditional networking strategies. Our findings identify networking strategies that appear to work and those that do not. Recommendations for improving communication are provided.     

Mental Health Literacy and Peer-to-Peer Counseling Referrals Among Community College Students

Mental health literacy (MHL) has utility for promoting peer-to-peer referrals to mental health support services among university students. However, there is a gap in the extant literature about the potential usefulness of MHL for supporting the mental health of community college students, a population facing a number of mental health conditions. The authors examined the construct validity and the utility of 3 dimensions of MHL as predictors of peer-to-peer referrals to the counseling center among community college students. Results of confirmatory factor analyses supported the dimensionality of the instrumentation and a hierarchical logistic regression analysis revealed that MHL was a significant positive predictor of peer-to-peer referrals to the counseling center. Implications for counseling practice and future research are discussed.     

Ageism in Mental Health and Health Care: A Critical Review

Discussions of aging and mental health widely assume that ageism among mental health providers is an important factor limiting access to mental health services for older adults. Given the widespread citation of ageism as a problem, we critically review the history of the ageism construct, and evidence for its existence in both mental health and medical professionals. There is surprisingly little empirical evidence for age bias among mental health providers. Considerable evidence does suggest differential medical treatment for older adults in such diverse areas as physician–patient interaction, use of screening procedures, and treatment of varied medical problems, although it is unclear whether age bias accounts for these differences. We suggest that innovations in delivery of psychological services, such as collaborative medical/psychological care in primary care settings, may ultimately prove more useful in improving access to mental health services than efforts to combat ageism.     

目前国内常用心理健康量表的回顾与反思

对国内近10多年来常被用于评鉴心理健康的7大类量表的分析结果表明,我国常用心理健康评估工具具有逐年增加、从单纯引进转向创造性地自编、自编量表的内容从学习与人格向多领域延伸、自编量表的方法从不完全到完全的特点。已编制出一些信效度较高的量表,但是仍存在一些问题。存在的主要问题是量表的信效度较低、自编量表有低水平重复现象、测量积极心理的量表少。     

In-Session Stuck Points and Pitfalls of Community Clinicians Learning CBT: Qualitative Investigation

Given the preponderance of evidence supporting the efficacy of cognitive behavior therapy (CBT), there has been an increased emphasis on dissemination to community mental health systems (CMH). Trainers from two large-scale dissemination initiatives (n = 27) were surveyed regarding the common pitfalls and difficulties encountered by CMH clinicians learning CBT. Common pitfalls were organized according to the items of the Cognitive Therapy Rating Scale (CTRS; Young & Beck, 1980) and reviewed. Guided discovery was reported to be the most challenging CBT competency to learn. Qualitative methods were used to construct a grounded theory; trainer responses indicated they viewed the practice of CBT as not only a set of discrete skills, but also a way of thinking. Efforts may be needed to provide support, assistance, and resources to these CMH clinicians as they continue to build CBT competency.     

Twenty Years Post‐genocide: The Creation of Mental Health Competence among Rwandan Survivors Through Community‐based Healing Workshops

Twenty years after the genocide, many Rwandans still suffer from the psychological wounds of the past. The country's mental health agenda is based on individualised and psychiatric approaches that help some but cannot be provided on a large scale. Further, many reconciliation initiatives have been based on public testimonies, which have been shown to be potentially re‐traumatising, leading to calls for small‐scale community‐based approaches to healing, which constitute a middle way between individualised and public approaches. Drawing on the concept of ‘mental health competence’ (Campbell and Burgess, 2012), this study evaluates one such approach: the Life Wounds Healing workshops offered by the African Institute for Integral Psychology. Twenty‐one semi‐structured interviews were conducted with former workshop participants, staff members and the institute's founder to investigate their views on how these workshops can help genocide survivors. The results suggest that the workshops succeed in creating mental health competence by establishing a safe social space for people to open up, increasing people's critical understandings of the processes of pain — and potential for healing — that informs behaviour change, generating bonding social capital and offering participants' income‐generating possibilities. Copyright © 2015 John Wiley & Sons, Ltd.     

Understanding Islamic Perspective of Mental Health and Psychotherapy

This paper is an attempt to provide foundational information about Islamic perspective of mental health and psychotherapy. It further highlights the historical contribution of Muslim philosophers and physicians to the field of psychotherapy. In the aftermath of the 9/11 and 7/7 tragedies, there has been a growing need to understand the Islamic perspective of mental health and gain insight into the followers of this faith otherwise perceived as ‘mysterious and Far Eastern’. A case example illustrates how counselors/therapists can effectively incorporate religious-cultural aspects of Islam in their work with Muslim clients so that they could work more effectively with their Muslim clients in the post 9/11 climate. Health care professionals must be sensitive to and fully aware of the unique religious traditions, cultural norms and gender sensitive values of their Islamic psychiatric patients so that they could introduce modern therapeutic interventions with less resistance from their clients.