Applying motivational interviewing principles in a modified interpersonal group for comorbid addiction

The application of motivational interviewing (MI) principles in modified interpersonal group therapy (MIGT) addresses two gaps in the literature. First, it explicitly extends MIGT to non-abstinent, addicted patients who are in the precontemplative and contemplative stages of change in contrast to most MIGT models where abstinence is usually required. Second, it provides a novel, process-oriented group intervention for MI, in contrast to current applications of group-based MI which are more structured in their format. The main modification in technique was to prioritize the horizontal exploration of substance use disclosures with a focus on the here-and-now experience of disclosure and the interpersonal impact on the group, in order to: (1) encourage members to openly discuss their ambivalence and shifting motivational states, (2) harness the evocative impact of substance use disclosures between members to elicit change talk (self-motivational statements), and (3) selectively reinforce change talk when it emerges from these exchanges. The authors illustrate these concepts with a case report of an open-ended MIGT group with comorbid mental illness and addiction.     

Integrated treatment of co-occurring mental illness and addiction: clinical intervention, program, and system perspectives

Individuals with mental illness and addiction comprise at least half of the patients in most mental health treatment systems. This combination results in increased risk for frequent psychiatric relapses, poor medication compliance, violence, suicide, legal problems, and high utilization of the emergency room or inpatient services. Traditional mental health and addiction treatments have not adequately addressed these co-occurring disorders due to clinical interventions, programs, and system flaws that have not addressed the individual's needs. Integrated treatment requires both an understanding of mental illness and addiction and the means to integrate and modify the traditional treatment approaches in both the mental health and addiction treatment fields. There is strong evidence to support the efficacy and effectiveness of integrated treatment in this population. All mental health clinicians should become experienced and skilled in the core psychotherapy approaches to treating substance use disorders, including motivational enhancement therapy, relapse prevention (cognitive-behavioral therapy), and 12-step facilitation. In addition, integrated treatment includes integrating medications for both addiction and mental illness with the behavioral therapies and other psychosocial interventions. This article reviews the clinical intervention, program, and system components of integrated treatment and specific clinical interventions for this population.     

The Person in Distress: On the Biosocial Dynamics of Adaptation

Abstract

The application of Motivational Interviewing (MI) principles in Modified Interpersonal Group Therapy (MIGT) addresses two gaps in the literature. First, it explicitly extends MIGT to non-abstinent, addicted patients who are in the precontemplative and contemplative stages of change in contrast to most MIGT models where abstinence is usually required. Second, it provides a novel, process-oriented group intervention for MI, in contrast to current applications of group-based MI which are more structured in their format. The main modification in technique was to prioritize the horizontal exploration of substance use disclosures with a focus on the here-and-now experience of disclosure and the interpersonal impact on the group, in order to: 1) encourage members to openly discuss their ambivalence and shifting motivational states, 2) harness the evocative impact of substance use disclosures between members to elicit change talk (self-motivational statements), and 3) selectively reinforce change talk when it emerges from these exchanges. The authors illustrate these concepts with a case report of an open-ended MIGT group with comorbid mental illness and addiction.     

Mental Health Identification Practices of Jails: The Unmet Needs of the “Silent” Population

The overrepresentation of individuals with mental illness in the criminal/legal system is well documented. While professional associations urge diversion towards treatment, little is known about the practices these institutions use to identify this population. One understudied space in the criminal/legal continuum is jails. This exploratory study compares two types of mental health identification at jail booking to assess jail‐ and community‐based service outcomes by identification type (N = 2956): (a) staff observation and (b) a standardized screening instrument. Individuals identified through staff observation were significantly more likely to receive jail‐ and community‐based services, even though current symptomology and substance misuse were both significantly higher for individuals identified only by the screening instrument. These findings point to the importance of jails in providing stabilizing services during incarceration, but further, show the impact that identification practices have on individuals as they transition to the community. Community context showed varied rates of jail staff observations of mental illness, showing greater risks for individuals in rural communities. Implications include a need for system‐level changes by instituting evidence‐based identification practices in jails, and improving professional collaboration practices between mental health and criminal/legal practitioners as individuals enter and exit jails.     

L’évaluation psychologique en situation transculturelle : une révision de la littérature

Human migration provokes transcultural clinical encounters that may challenge the way clinicians see themselves and how they proceed in their usual practices. In the field of psychology, psychological assessment is an important tool to better understand the patients’ needs and to design psychological interventions. Considering that most diagnostic tests and manuals have been developed in the Western context, the application of these tools with other populations remains controversial. The present literature review aims to describe the state of current knowledge on psychological transcultural assessment. Specifically, we will address: (1) the use of psychological tests in transcultural contexts, (2) the development of the Cultural Formulation Interview (CFI, DSM-5) and (3) the clinical interview: language, therapeutic relationship and participation of interpreters. In the first section, we discuss the international norms for scales and tests translation and adaptation, as well as the cultural issues that may bias the test’ application and interpretation. In the second section, we describe the creation of the CFI, and its use in recent studies. The CFI is composed by four clusters: (1) cultural definition of a problem, (2) cultural perceptions of cause, context, and support, (3) cultural factors affecting self-coping and past help seeking, and (4) cultural factors affecting current help seeking. The revised studies indicated that the CFI has a positive impact on the cultural sensibilization of mental health professionals, also improving the relationship between the patients and professionals. The cultural formulation may also prevent misdiagnosis. Beyond the use of tests and structured interviews, the clinician also faces other challenges during a transcultural assessment. We discuss in the third section the transferential and countertransferential relationship in a transcultural situation. Several elements may influence this relationship, at an individual, institutional and societal level. The evaluation of these elements may allow the clinician to better understand results of the psychological assessment. We also describe the current guidelines for the use of interpreters during health consultations in France. In conclusion, several advances have been made in the field of transcultural psychological assessment, among other things the development of guides for good translation and cultural adaptation of tools, as well as the integration of cultural issues into the DSM. However, research and changes in clinical practice are still needed, as the evaluation of cultural biases in cognitive tests and the expansion of cultural competences training among clinicians.     

A Systematic Review of the Literature Exploring Illness Perceptions in Mental Health Utilising the Self-Regulation Model

Psychologists have utilised a range of social cognition models to understand variation in physical health and illness-related behaviours. The most widely studied model of illness perceptions has been the Self-Regulation Model (SRM, Leventhal, Nerenz, & Steele, 1984). The illness perceptions questionnaire (IPQ) and its revised version (IPQ-R) have been utilised to explore illness beliefs in physical health. This review examined 13 quantitative studies, which used the IPQ and IPQ-R in mental health in their exploration of illness perceptions in psychosis, bipolar disorder, eating disorders, depression and adolescents experiencing mood disorders. Across these studies the SRM illness dimensions were largely supported. Mental illnesses were commonly viewed as cyclical and chronic, with serious negative consequences. Perceptions regarding chronicity, controllability and negative consequences were associated with coping and help seeking, while engagement with services and help seeking were also related to illness coherence beliefs. Treatment adherence was linked to beliefs that treatment could control one’s illness. Whilst a major limitation of the reviewed studies was the use of cross-sectional designs, overall the applicability of the SRM to mental health was supported. The IPQ and IPQ-R were shown to be valuable measures of illness perceptions in mental health, offering implications for clinical practice.     

Addiction in Maternity: Prevalence of Mental Illness,Substance Use,and Trauma

Women living in vulnerable neighborhoods experience higher rates of poverty, homelessness, psychiatric issues, illicit substance use, rates of HIV, and a lowered life expectancy. The aim of the study was to further explore the history of mental illness and trauma in a sample of women (N?=?31) who had recently given birth and had a substance use problem while pregnant. We investigated sociodemographic characteristics, history of trauma and post-traumatic stress disorder (PTSD), rates of substance use and dependence, and psychiatric symptoms. Childhood and adult traumatic experiences were found in the majority of the sample, and one-third presented with suspected PTSD diagnosis at the time of the interview. Women-centered services are in great demand, as well as trauma informed care, and further research on appropriate treatment for substance using, traumatized, women with a mental illness.     

Adolescents' Attitudes About the Role of Mental Illness in Suicide,and Their Association with Suicide Risk

We examined teenagers' attitudes about the role of mental illness in suicidal behavior and the relationship between these attitudes and suicide risk. Serious suicidal ideation or behavior and associated risk factors (gender, depression, substance problems, and first‐hand experience with a suicidal peer) were assessed in 2,419 students at six New York high schools. Less than one fifth of students thought that mental illness was a major contributor to suicide. Suicidal adolescents and those at risk were less likely than their nonsuicidal and low‐risk counterparts to associate suicide with mental illness. Our findings contribute to the debate over whether accepting attitudes toward suicide increase suicide risk.     

Psychological stigma costs as barriers to healthcare use in former soldiers of the German Armed Forces: A qualitative analysis

Individuals decide to use healthcare when the expected benefits outweigh the perceived costs. One of these cost factors in this decision can be stigma. So far, it has not been researched how former soldiers of the German Armed Forces with a service-induced mental illness perceive stigma and how it influences their healthcare use. As stigma is shaped by the socio-cultural context, the setting of the potential healthcare use must be considered. Narrative interviews were conducted with 33 former soldiers with mental health problems. The data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. The relationship between stigma and healthcare use was analyzed. Occupational discrimination and social exclusion were experienced in both in the military and civilian context, but stigma functioned differently in each context. In the military context, former soldiers’ self-stigma of mentally ill individuals being weak was in stark contrast to their internalized military standards. This contrast let them avoid disclosure and subsequent healthcare use. In civilian context, the participants perceived 2 different stigma costs: mental illness stigma and former soldier stigma (i.e., stigmatization because of their military past). Both were perceived as barriers to healthcare use. A model, illustrating these different stigma costs in the different contexts, was developed. Further research on the link between stigma and healthcare use of this group is urgently needed.     

Marshaling administrative data to study the prevalence of mental illness in assault on law enforcement cases

A substantial body of literature has investigated many issues surrounding police encounters with persons with mental illness. This paper focuses on a specific type of encounter – individuals with mental illness charged with assaulting officers because of their behavior during a psychiatric crisis – and uses administrative data to examine its prevalence in one state. Results suggest that individuals with mental health histories comprise a small but meaningful percentage (c. 9%) of assault on law enforcement charges, and c. 10% of these charges have an offense date within 14 days of an emergency mental health custody order, increasing the likelihood that psychiatric symptoms influenced their behavior at the time of the offense. Further results describe different categories of relevant charges, charge classifications, final dispositions, and sentences. Results are discussed in the context of outcomes for persons with mental illness and law enforcement as well as the role and limitations of forensic mental health assessment in these cases. The paper concludes with a call for similar data collection across jurisdictions.     

A Multidimensional Approach to Apathy after Traumatic Brain Injury

Apathy is commonly described following traumatic brain injury (TBI) and is associated with serious consequences, notably for patients’ participation in rehabilitation, family life and later social reintegration. There is strong evidence in the literature of the multidimensional nature of apathy (behavioural, cognitive and emotional), but the processes underlying each dimension are still unclear. The purpose of this article is first, to provide a critical review of the current definitions and instruments used to measure apathy in neurological and psychiatric disorders, and second, to review the prevalence, characteristics, neuroanatomical correlates, relationships with other neurobehavioural disorders and mechanisms of apathy in the TBI population. In this context, we propose a new multidimensional framework that takes into account the various mechanisms at play in the facets of apathy, including not only cognitive factors, especially executive, but also affective factors (e.g., negative mood), motivational variables (e.g., anticipatory pleasure) and aspects related to personal identity (e.g., self-esteem). Future investigations that consider these various factors will help improve the understanding of apathy. This theoretical framework opens up relevant prospects for better clinical assessment and rehabilitation of these frequently described motivational disorders in patients with brain injury.     

Use of Legal Drugs by Psychiatric Outpatients: Benefits, Costs, and Change

Caffeine, nicotine, and alcohol use by persons with a severe mental illness occurs frequently but is poorly understood. We used qualitative methods to elicit information regarding the functional relationships between legal substance use and its antecedents and consequences. This report summarizes responses provided by 37 psychiatric outpatients who participated in focus groups and key informant interviews regarding the use and functions of alcohol, caffeine, and nicotine. We describe major themes regarding positive and negative consequences, triggers for use, change efforts, and offer observations regarding substance use in this under-served population.     

Mental health consultation to law enforcement: Secret Service development of a Mental Health Liaison Program

The Mental Health Liaison Program developed and used by the Secret Service is presented as a model for comprehensive, multidimensional interactions between law enforcement and mental health systems, with particular focus on assessing and preventing violent behavior. The structure of the program pairs consultants—psychologists and psychiatrists—with Secret Service field offices to provide (a) consultation regarding risk assessment and case management of individuals who threaten or display inappropriate interest in the President or other protectees; (b) training for agents on risk assessment, mental illness, and mental health care issues; and (c) liaison activities between the Secret Service and the mental health community. Practical benefits to the Secret Service are discussed to encourage more systematic use of broad based psychological and psychiatric consultation to law enforcement, with a goal of enhanced intersystem communication and collaboration. The need for program evaluation and outcome research is discussed in the context of applying the model to improve other mental health and law enforcement systems interactions. © 1998 John Wiley & Sons, Ltd.     

Factors associated with perceived helpfulness and use of mental health websites by Australian young adults with a family history of mental illness

Young adults with a family history of mental illness may be vulnerable to develop mental health conditions based on genetic and environmental features. This study aimed to explore factors associated with the use of mental health websites for young adults aged 18–30 years who reported a family history of mental illness. Young adults (n = 469) who reported a family history of mental illness completed an online survey regarding their use of mental health websites, demographic questionnaires and the Depression, Anxiety and Stress Scales. In total, 194 (41%) participants reported using mental health websites, with the majority using these for their own mental well-being (n = 156; 33%). Having a previous history of a mental health condition was associated with mental health website use, along with having a prior history of drug use and having more than one family member diagnosed with a mental illness.     

The Stigma of Mental Illness

Stigma surrounding major mental illness creates many barriers. People who experience mental illness face discrimination and prejudice when renting homes, applying for jobs, and accessing mental health services. The authors review the current literature regarding stigma and mental illness. They define stigma and review theories that explain its impact. Counselor training is a peak time to identify and begin to mitigate stigma related to people with mental illness. Implications for counselor training are addressed.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

The impact of religious behaviours on the health and well-being of emerging adults

Emerging adulthood is a life stage in which the frequency of religious behaviours often wanes while the risk of mental illness, substance abuse, and risky sexual behaviour increases. The current study explores the role that religious behaviours might play in mitigating these risks among college-attending emerging adults. Survey data were collected on religious service attendance, prayer and meditation, substance use, sexual activity, and life satisfaction. Results revealed a significant effect for religious service attendance on substance use and sexual behaviour and for the frequency of prayer/meditation on life satisfaction, marijuana use, and sexual intercourse. Group comparisons revealed that emerging adults who participated in religious activities reported lower rates of substance use, less sexual behaviour, and greater satisfaction with life. Limitations and suggestions for future research are discussed.     

Mental Health Disparities,Treatment Engagement,and Attrition Among Racial/Ethnic Minorities with Severe Mental Illness: A Review

Mounting evidence indicates that there are mental health disparities in the United States that disadvantage racial/ethnic minorities in medical and mental health settings. Less is known, however, about how these findings apply to a particularly vulnerable population, individuals with severe mental illness (SMI). The aim of this paper is to (1) provide a critical review of the literature on racial/ethnic disparities in mental health care among individuals with SMI; (2) identify factors which may contribute to the observed disparities; and (3) generate recommendations on how best to address these disparities. Specifically, this article provides an in-depth review of sociocultural factors that may contribute to differences in treatment engagement and rates of attrition from treatment among racial/ethnic minorities with SMI who present at medical and mental health facilities. This review is followed by a discussion of specific strategies that may promote engagement in mental health services and therefore reduce racial/ethnic disparities in SMI.