心理疾病自我污名:心理康复的一个高危因子

心理疾病自我污名是心理疾病患者内化公众的消极刻板印象、偏见和歧视,形成自我偏见和歧视的现象.心理疾病自我污名会给患者带来一系列的负面影响,是心理康复过程中的一个高危因子.自我污名可能是通过引发患者的消极认知、负面情感和自我歧视行为来危及心理康复过程的.对自我污名的干预应针对患者和社会公众分别加以实施.未来可以从理论构建、测量工具和干预措施的改进,以及去污名与心理康复的融合等方面展开自我污名本土化的研究.     

Influences on the Food Choice Behaviors of Adults With Severe Mental Illness

The objective of this research was to gain a deeper understanding of factors influencing the healthiness of food choice behaviors of community-dwelling adults with severe mental illness. Semi-structured interviews were conducted in an outpatient treatment facility with 20 program participants and 10 staff. Grounded theory analysis methods were used. Five dominant themes emerged: food availability, preference for simple food preparation, perceived cost of food, complexity of choice, and relative importance of healthy food choices. The theme of medication effects only emerged from staff interviews. This research can be useful to inform the design of nutrition interventions for this population.     

Patient Responsiveness to a Sleep and Circadian Intervention in a Sample of Adults With Serious Mental Illness

Understanding patient responsiveness, a component of fidelity, is essential as it impacts treatment outcome and ongoing use of treatment elements. This study evaluated patient responsiveness—operationalized as receptivity to treatment modules and ratings of the usefulness and the utilization of treatment elements—to the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) in a sample of adults with serious mental illness (SMI) and sleep/circadian dysfunction. Adults with SMI and sleep/circadian dysfunction (N = 104) received TranS-C in a community mental health setting. Independent raters rated TranS-C sessions to assess receptivity. At posttreatment and 6-month follow-up, participants completed a usefulness scale, utilization scale, the PROMIS Sleep Disturbance (PROMIS-SD) and Sleep-Related Impairment (PROMIS-SRI) scales, DSM-5 Cross-Cutting Measure (DSM-5-CC), and Sheehan Disability Scale (SDS). Receptivity was rated as somewhat to fully understood, and predicted a reduction on the DSM-5-CC. On average, participants rated TranS-C as moderately useful and utilized treatment elements occasionally. Ratings of usefulness were associated with the PROMIS-SD, PROMIS-SRI, and DSM-5-CC at posttreatment, but not with the SDS. Ratings of utilization were not associated with outcome. The findings add to the literature on patient responsiveness, an implementation outcome, and provide data on the utility of TranS-C within a community mental health setting.     

Developing Roles and Skills in Community-Living Adults With Severe and Persistent Mental Illness

People with severe and persistent mental illness often experience a disruption in the development of social roles, and the skills within these roles. Role Development, a set of guidelines for practice, is an intervention to develop roles and skills. The purpose of this study was to continue to examine the efficacy of this intervention. Ten people attending two community mental health programs participated in evaluation and treatment based on Role Development. Quantitative pretest and posttest measures were used. Qualitative components were incorporated to get a sense of the experience involved in developing roles and skills. Quantitative results indicated statistical significance (p < .05) in the development of roles and skills. Qualitative data revealed multiple trends experienced by the participants. This study contributes to the evidenced-based knowledge regarding development of roles and skills for persons living with severe and persistent mental illness.     

A Geographic Analysis of Chronically Homeless Adults Before and After Enrollment in a Multi-Site Supported Housing Initiative: Community Characteristics and Migration

The current study examined the community characteristics and migration of chronically homeless adults before and after entry into a multi-site supported housing initiative. A total of 394 participants were geocoded at baseline and 12-month follow up. Data from geographic information systems indicate that the median distance participants traveled from their last residence to their residence 1 year after program entry was 4.6 miles and 12% of participants traveled more than 100 miles. Participants moved into communities with higher population densities, larger proportions of Whites, and smaller proportions of Blacks following their entry into supported housing, but continued to live in communities with higher crime rates, lower education levels, and lower income levels then the state average. At 12 months, Black participants residing in communities with higher population densities and larger Black populations reported higher social support and lower subjective distress. This underscores the importance of considering client preferences in housing. Together, these findings suggest that supported housing programs may be successful in finding housing for homeless clients, but are not placing them in improved communities. Special attention may also be needed for some clients who travel long distances between residences.     

The Effects of Repeated Exposure to the ARRAY Program With Offenders With Mental Illness

In an A‐B‐A‐B‐A single‐case research study of 3 incarcerated offenders with mental illness, repeated exposure to the pilot Adult Recidivism Reduction Alternatives (ARRAY) group counseling intervention was an effective or very effective treatment for anxiety, depression, and associated somatic symptoms.     

Stress Management with Law Enforcement Personnel: A Controlled Outcome Study of EMDR Versus a Traditional Stress Management Program

Eye Movement Desensitization and Reprocessing (EMDR) has been shown to be effective for treating posttraumatic stress disorder, but its efficacy as a stress management tool for normal individuals in highly stressful occupations has not been demonstrated. Sixty-two police officers were randomly assigned to either EMDR or a standard stress management program (SMP), each consisting of 6 hours of individualized contact. At completion, officers in the EMDR condition provided lower ratings on measures of PTSD symptoms, subjective distress, job stress, and anger; and higher marital satisfaction ratings than those in SMP. The effects of EMDR were maintained at the 6-month follow-up, indicating enduring gains from a relatively brief treatment regimen for this subclinical sample of officers who were experiencing some level of stress from their job.     

Ethical Challenges and Legal Issues for Mental Health Professionals Working With Family Caregivers of Individuals With Serious Mental Illness

Mental health professionals frequently work with family caregivers in the provision of psychotherapy services to individuals with serious mental illness. To address the need for ethical guidelines for working with family caregivers, an analysis of relevant ethical and legal issues is provided within the context of dynamic mental health care and legal systems. When working with family caregivers, practitioners utilize the American Psychological Association’s Ethics Code (2010), legal codes, and a complex decision-making plan; identify and communicate ethical obligations to family caregivers; consider the unmet needs of this population; avoid harm resulting from multiple relationships; and balance ethical duties of beneficence and respect for autonomy.     

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.     

Effectiveness of a Comprehensive Worksite Stress Management Program: Combining Organizational and Individual Interventions

A comprehensive worksite stress management program consisting of self-management training and a stressor reduction process was evaluated in a pre-post, treatment-control design in four comparable facilities. Results showed that over a 3-month period those individuals attending self-management training improved on emotional well-being measures. Organizational data suggested that their work-units' productivity increased and absenteeism decreased over the same period. Results support the value of combining self-management training and stressor reduction to produce positive individual and organizational outcomes.     

The Effectiveness of a Consultation Model in Community Mental Health

This one-year study explored the impact of an occupational therapy consultation model on housing status and goal attainment among 57 people with severe mental illness who were homeless or at risk of homelessness. A repeated-measure experimental design was used. Although results were mixed, the significant improvement in housing stability and goal attainment six months into the study supports the value of continued research on the effects of both direct and consultative occupational therapy intervention on client goal attainment.     

Applying a Time‐Patterned Typology of Homelessness Among Individuals with Mental Illness

Identification of subgroups of the homeless populations, or typologies, has been an important research priority to guide homelessness services and policies. This study builds on previous typological research conducted in the general homeless population by focusing on individuals with mental illness to further delineate typologies within a more homogenous subset of the homeless population. A time‐patterned typology based on episodes of street and shelter homelessness over a four‐year period was applied to a sample of 246 individuals identified through mental health administrative records. Four groups were created based upon patterns of homelessness: 26.8% experienced homelessness for 4 years, 13.4% had one episode of homelessness but were no longer homeless at the end of the follow‐up, 48.4% had at least two episodes of homelessness, and 11.4% had a single episode of homelessness lasting 3 months or less. Findings from a multinomial logistic regression indicated that gender, presence of a psychotic disorder, substance abuse, and year of study enrollment significantly predicted group membership. Residential trajectories upon exit from homelessness and at the end of the four‐year follow‐up were examined. Implications for current policy and future research are discussed.     

Worksite Stress Management with High-Risk Maintenance Workers: A Controlled Study

This study evaluated effects of a worksite stress management/health promotion program with primarily minority blue-collar employees showing a number of high-risk health behaviors. In a biopsychosocial approach, participants were assessed with a standardized health risk appraisal that included physical and behavioral variables, plus measures of self-control, health attitudes/satisfaction, and other factors. A controlled group design was employed with pretreatment, treatment, posttreatment, and three-month follow-up. Participants were randomly assigned to a wait-listed control group (n = 26) and a health promotion intervention group (n = 24). The latter received a multimodal intervention including stress management training, educational workshops and counseling, and a self-directed behavior change program. Following posttreatment assessment, the control subjects were given treatment and their data were then added to that of the initial treatment group to comprise a total group of treatment finishers (n = 33). The results revealed a number of significant differences between the two groups at posttreatment and/or for the treatment finishers across time (pretreatment vs. posttreatment and/or follow-up), including certain of the physical and behavioral measures, self-efficacy, and some health attitudes, but no effects for job-related measures, such as absenteeism and job satisfaction.     

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.     

A Holistic Client Functioning Profile Comparison of People With Serious Mental Illness

Among a sample of 196 participants, small differences in holistic client functioning, as measured by standardized Adult Needs and Strengths Assessment (Lyons & Walton, 1999) and symptom severity scores, emerged across 3 diagnostic categories of serious mental illness (SMI; i.e., depression, bipolar disorder, and schizophrenia). However, sizable variations in symptom severity were evident across diagnoses of SMI, despite study participants receiving a similar configuration and intensity of recovery-oriented usual-care services. These results may evidence previous concerns surrounding the transdiagnosis of SMI, overlapping criteria and symptomatology among disorders in the Diagnostic and Statistical Manual of Mental Disorders, and mental health treatment and service practices in the United States. Implications for counselor practice are discussed.     

Outcomes From the Transdiagnostic Sleep and Circadian Intervention (TranS-C) for Midlife and Older Adults With Serious Mental Illness and Sleep and Circadian Dysfunction

The present study tested outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) among midlife and older adults with serious mental illness (SMI). Further, we tested predictors—credibility, expectancy, usefulness, and utilization—that may affect TranS-C outcomes. Midlife and older participants from a community setting (>49 years, 62.3% female, 37.7% African American or Black) with sleep and circadian problems and SMI were randomized to receive TranS-C plus usual care (TranS-C+UC, n = 27) or usual care followed by delayed treatment with TranS-C (UC-DT, n = 26). Immediate and delayed TranS-C data were combined to increase power (combined n = 52). Outcomes were assessed at pretreatment, posttreatment, and 6-month follow-up. Credibility and expectancy were assessed during the second session. Usefulness and utilization of TranS-C skills were assessed at posttreatment and 6-month follow-up. TranS-C+UC, relative to UC-DT, was associated with improvements in depression symptoms, sleep disturbance, overall sleep health, and select sleep/wake outcomes, though not all improvements were sustained at 6-month follow-up. Lower usefulness of TranS-C skills predicted more severe sleep disturbance at posttreatment and daytime sleep-related impairment at posttreatment and 6-month follow-up. Lower utilization predicted more severe psychiatric symptoms at posttreatment, sleep disturbance at posttreatment and 6-month follow-up, and overall impairment and daytime sleep-related impairment at 6-month follow-up. Higher credibility and expectancy predicted greater usefulness of TranS-C skills at posttreatment and 6-month follow-up and greater utilization at 6-month follow-up. Together, findings highlight benefits of TranS-C for midlife and older adults with SMI. However, boosting credibility, expectancy, utilization, and usefulness may meaningfully improve TranS-C outcomes.     

大陆和台湾地区精神疾病患者强制住院医疗之比较研究

精神病患者是社会弱势群体,其权利易遭受他人的侵害,同时其有可能对他人权利造成损害。因此为维护本人和他人权利,有必要对其实施特殊的措施。大陆和台湾地区均规定对严重精神病患者实施强制住院医疗措施,但二者在强制医疗的对象、程序以及人身自由的限制等方面存在重大差异。大陆强制医疗采取的是行政程序,而台湾地区是"准司法程序",其强制医疗决定由第三方作出。台湾地区精神卫生法为精神病患者提供了较为完善的权益保障体系。     

心理疾病内隐污名述评

心理疾病内隐污名是个体无法内省或精确识别的与心理疾病有关的痕迹, 它潜在地调节着个体对心理疾病患者的观念和行为。心理疾病内隐污名的主要测量方法包括内隐联想测验、简式内隐联想测验、启动任务和生理心理测量。当前该研究领域集中在内隐污名的成分、公众内隐污名、自我内隐污名、去污名化评估等方面。未来研究可从心理疾病内隐污名的构成与结构、认知神经基础、测量整合和本土化等角度做进一步探讨。     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

Consumer Preference Programs for Individuals Who Are Homeless and Have Psychiatric Disabilities: A Drop-In Center and a Supported Housing Program

We illustrate Fairweather's approach to Experimental Social Innovation and Dissemination with two experimental studies of programs to reduce homelessness for 168 and 225 people with mental illness and often substance abuse. Literally homeless participants were randomly assigned to programs that emphasized consumer choice or to the usual continuum of care, in which housing and services are contingent on sobriety and progress in treatment. A drop-in center that eliminated barriers to access to services was more successful than control programs in reducing homelessness, but after 24 months only 38% of participants had moved to community housing. A subsequent apartment program, in which individuals in the experimental condition moved to subsidized apartments directly from the street, with services under their control, had 79% in stable housing (compared to 27% in the control group) at the end of 6 months. Groups in this study did not differ on substance abuse or psychosocial outcomes.