Applied Research and Evaluation in Community Mental Health Services

Applied Research and Evaluation in Community Mental Health Services: An Update of Key Research Domains

Copyright Date: 2011
Pages: 384
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  • Book Info
    Applied Research and Evaluation in Community Mental Health Services
    Book Description:

    The burden of mental illness on individuals, families, and communities has created profound challenges for our society. In recent years treatments and services for the mentally ill have moved almost exclusively to community settings, yet no comprehensive and progressive policies have emerged to counter stigmatizing and facilitate integration.

    eISBN: 978-0-7735-8656-7
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-2)
  4. 1 Introduction
    (pp. 3-15)
    Evelyn R. Vingilis and Stephen A. State

    Mental illness is a profoundly challenging disease, challenging first of all to those who suffer with it, since in many cases the symptoms of the illness will impair family and social relationships, as well as economic well-being. Instead of receiving sympathy, those who suffer with mental illness are more likely to experience stigma and isolation. And there is less likely to be appropriate treatment for them than for those who suffer from other diseases. According to a 2008 study, in high-income countries 23.7 percent of persons with a mental illness received treatment, compared to almost 65 percent of persons with...

  5. 2 Community-Based Treatment: A New Idea a Hundred Years and More in the Making
    (pp. 16-32)
    Stephen A. State

    The “deinstitutionalization” label as applied to a process of change in the locus of delivery of mental health services from institution to community is now approaching at least half a century of continuous use. Its precursors are older still. If we quite plausibly included the guiding ideas of the 1915 Maudsely Hospital in London, which included out-patient treatment of voluntary patients (Jones 1993, 126), and the very similar ideas underlying the Boston Psychopathic Hospital’s outdoor programs inspired by the mental hygiene movementcirca1910, de-institutionalization would be approaching its centennial. Or if we were to include the programs and practices...

  6. 3 Issues and Challenges in Community Mental Health Services: Program and Policy Evaluation
    (pp. 33-54)
    Evelyn R. Vingilis

    The last two decades have seen the development of a strong movement for “evidence-based” health care. Although a key rationale for evidence-based care has been to provide health care providers and patients/clients/consumers with information about outcomes of the best-evaluated interventions so that they are able to make more informed decisions about care, it is also acknowledged that one driving force behind evidence-based health care is fiscal – the goal is for health care funding agencies to find the most cost-effective health care option (Barnes et al. 1999; Fonagy 1999; Guyatt et al. 1995). The problem of obtaining the “biggest bang for...

  7. 4 Interfacing Hospital and Community Mental Health Services: The Role of the Emergency Department
    (pp. 55-67)
    Beth Mitchell

    Hospitals have always played a significant role in the mental health system. Historically, they were the primary site of psychiatric care, which tended to be long-term, inpatient-based, and custodial in approach (see chapter 2, this volume). Hospitals were places of refuge, of protection, of assessment and diagnosis, and of treatment; they reflected the best – and at times, the worst – of interventions with individuals suffering from mental illness. As models of mental health care evolved and the emphasis on early intervention with mental illness and recovery in the community grew, hospitals were required to change and offer new services that focused...

  8. 5 Research on Community Treatment Orders
    (pp. 68-79)
    Richard O’Reilly

    Community treatment orders (CTOs) are legal provisions that require an individual with a mental illness to follow a program of treatment when living outside a hospital. Typically, CTOs are used for individuals who respond to treatment when hospitalized but who repeatedly discontinue treatment and relapse following discharge. In most Canadian provinces, apart from Quebec, a physician initiates the treatment order. Quebec is similar to the United States in that only a court can authorize mandatory treatment to take place in the community. The term, outpatient committal, is often used in the United States to describe court-ordered treatment for non-hospitalized patients....

  9. 6 The Criminalization of Mental Illness
    (pp. 80-93)
    Virginia Aldigé Hiday and Heathcote W. Wales

    Most persons with mental illness, even most with severe mental illness,¹ either do not receive treatment in the mental health system or do not stay in care (Kessler et al. 1994; Leaf and Bruce 1987; Shapiro et al. 1985). But a large proportion of persons with severe mental illness who become public mental health clients come into contact with the criminal justice system through arrest, criminal incarceration, parole, probation, neighbourhood checks, and rescue from assaults and other crimes (Brekke et al. 2001; Clark et al. 1999; Monahan et al. 2005; Theriot and Segal 2005; Watson et al. 2008; Wolff et...

  10. 7 Perspectives on Violence Risk Assessment and Management in Mental Health Services
    (pp. 94-114)
    Anne Crocker, Gilles Côté and Erika Braithwaite

    Violence and aggressive behaviour among persons with severe mental illness (PSMI) not only pose important safety issues for the potential victims of these actions, often family members, mental health service staff, and other mentally ill individuals, but they also create significant management problems for mental health service providers. Violent behaviour further limits an individual’s potential for rehabilitation and recovery and in some cases also limits access to evidence-based mental health services such as integrated dual-disorder treatment and first-episode psychoses programs, or to residential resources, educational or vocational programs, and leisure activities. In times of financial restraints and limited resources in...

  11. 8 The Social Stigma of Mental Illness
    (pp. 115-128)
    Ross Norman

    We are social beings. We depend on our relationships with others for meeting basic survival needs, fostering emotional well-being, and shaping our self-identity. At no point does the importance of our relationships with others become as apparent as when such relationships are threatened or diminished. The anticipation or experience of social rejection can, therefore, have profound implications for all aspects of our lives.

    It is well established that there are often strong and widespread negative reactions to those with serious mental illness (Corrigan and Watson 2002; Hayward and Bright 1997; Phelan et al. 2000; United States Department of Health and...

  12. 9 Consumer Participation in Mental Health Services
    (pp. 129-145)
    Geoffrey Nelson and Jill Grant

    The purpose of this chapter is to review and analyze consumer participation in mental health services and research. We begin by providing some background on consumer participation, its meaning, rationale, and historical roots. Next, we discuss the importance of values, as well as evidence, for mental health reform, and we make a distinction between ameliorative and transformative change. Bearing this distinction in mind, we then review research and experiences regarding consumer participation in policy, program governance, mainstream mental health services, consumer-run alternatives, and research. After discussing barriers to consumer participation and strategies to overcome them, we conclude with a discussion...

  13. 10 Housing and Mental Health
    (pp. 146-159)
    Cheryl Forchuk

    Housing has been recognized as a basic human need. Shelter is often described as one of the necessities for life itself. For this reason, Canada ratified the Universal Declaration of Human Rights and the International Covenant on Economic, Social and Cultural Rights in 1976 by recognizing housing as a human right (Hulchanski and Leckie 2000; Porter 2003). Housing is also a key determinant of health. In 1986 the World Health Organization’s Ottawa Charter for Health Promotion recognized adequate housing as a basic prerequisite for health. Recently, research has further established that housing is an important determinant of health and that...

  14. 11 Collaborative Mental Health Care: The Evolving Narrative in Primary Care
    (pp. 160-181)
    Raj Velamoor and Stephen A. State

    In this chapter we confine our focus to a research update in the somewhat narrow domain of collaborative mental health care in the primary-care sector. This will typically involve some more or less formal arrangement with a specialist in psychiatric care and/or other provider and/or a case manager. The collaboration is between or among professionals, with specialists providing guidance in the refinement of diagnosis and treatment and/or a liaison worker providing case-management functions. This confinement in perspective is needed simply because the domain of collaboration has become so large.¹

    Following some speculation as to why collaboration in mental health has...

  15. 12 Current Developments in Assertive Community Treatment
    (pp. 182-210)
    Joan Bishop, Lindsey George, Steve Lurie and Robert Wales

    Assertive Community Treatment, or ACT, is an evidence-based model of community care for people with severe mental illness who have significant difficulties in role functioning and daily living (Allness 1997; Lehman 1998; Ministry of Health and Long-Term Care 2004; Rosen et al. 2007). It was first developed in the 1970s in Wisconsin in the United States by a group of clinicians at Mendota State Hospital who believed that persons with severe mental illness should be given the opportunity to live in the community by receiving intensive treatment, rehabilitation, and support there, rather than on long-term mental hospital wards. They called...

  16. 13 Supported Employment
    (pp. 211-232)
    Eric Latimer

    People with severe mental illness (mainly schizophrenia, schizoaffective disorders, bipolar disorders, and major depression) represent 2 to 3 percent of the population (Kessler et al. 1999). Relatively few among this population work: even in the United States, where unemployment rates are low, only about 10 to 30 percent of people with severe mental illness work, including in sheltered settings (Rosenheck et al. 2006; Salkever et al. 2007). Yet various surveys conducted among people with severe mental illness who are users of mental health services suggest that about 60 to 70 percent of them would like to work (Drebing et al....

  17. Contributors
    (pp. 233-238)
  18. Bibliography
    (pp. 239-346)
  19. Index
    (pp. 347-367)