Outcomes of a Peer Mentor Intervention for Persons With Recurrent Psychiatric Hospitalization.

OBJECTIVE: This article presents findings from a randomized controlled trial of a peer support mentorship intervention designed for individuals with serious mental illness and frequent, recurrent psychiatric hospitalizations. METHODS: Seventy-six individuals who were diagnosed as having a major psychotic or mood disorder and who had at least two psychiatric hospitalizations or more than three emergency department visits within the 18 months prior to the index hospitalization participated in this trial. Participants were randomly assigned to one of two conditions: standard care or a peer mentor plus standard care. Substance use, psychiatric symptoms, psychosocial functioning, and hope were assessed at baseline and at three and nine months after hospital discharge. RESULTS: Participants assigned to the peer mentor condition reported significantly greater reductions in substance use and psychiatric symptoms and greater improvements in functioning compared with participants assigned to standard care. Moreover, participants in the peer mentor program remained out of the hospital for significantly longer periods of time compared with those assigned to standard care. CONCLUSIONS: Peer services for those who are hospitalized recurrently hold promise as an effective component of behavioral health care for persons with serious mental illnesses.

Effectiveness of peer support in reducing readmissions of persons with multiple psychiatric hospitalizations.

OBJECTIVE: The study examined the feasibility and effectiveness of using peer support to reduce recurrent psychiatric hospitalizations. METHODS: A randomized controlled design was used, with follow-up at nine months after an index discharge from an academically affiliated psychiatric hospital. Patients were 18 years or older with major mental illness and had been hospitalized three or more times in the prior 18 months. Seventy-four patients were recruited, randomly assigned to usual care (N=36) or to a peer mentor plus usual care (N=38), and assessed at nine months. RESULTS: Participants who were assigned a peer mentor had significantly fewer rehospitalizations (.89 ± 1.35 versus 1.53 ± 1.54; p=.042 [one-tailed]) and fewer hospital days (10.08 ± 17.31 versus 19.08 ± 21.63 days; p<.03, [one tailed]). CONCLUSIONS: Despite the study's limitations, findings suggest that use of peer mentors is a promising intervention for reducing recurrent psychiatric hospitalizations for patients at risk of readmission.

Qualitative study of high-cost patients in an urban primary care centre.

OBJECTIVES: We examined patient accounts of illness and care among primary care patients whose medical services costs were high in order to illuminate factors associated with high cost. METHODS: Thirty-three primary care patients with multiple chronic illnesses in an urban clinic serving a resource poor neighbourhood were selected from a range of high medical cost patients. Participants were interviewed with open-ended questions to investigate experiences of illnesses and care; their responses were examined for prominent themes using qualitative analysis methodology. RESULTS: Patients sorted themselves into two categories based on the dominant focus of the roles of the care givers: one termed 'professional', in which the focus was on the competence and effectiveness of the care giver; and the second, 'personal', in which the focus was on the interpersonal relationship. DISCUSSION: We examine similarities with other recent studies, suggest factors influencing these two different types of relationships such as intensity of involvement in the healthcare system as well as personality characteristics, and explore the challenge for healthcare programme development. We also noted that these two ways of conceptualizing the doctor-patient relationship may have adaptive or maladaptive consequences depending on the match between physician and patient.

Play, pleasure, and other positive life events: "non-specific" factors in recovery from mental illness?

As part of the emerging recovery paradigm, there is an increasing need for psychiatric treatment and rehabilitation to be strengths-based and to be driven by the desires and preferences of the person with mental illness. Yet if mental illness is a brain disease, it is not at all clear how these characteristics contribute to improvement in the person's condition or influence the course and outcome of the disorder. To avoid these aspects being relegated to the role of nonspecific factors, the field must develop an understanding of the role of strengths and interests in recovery. To contribute to this effort, we review the existing empirical research on the protective and stress-buffering effects of positive life events and qualitative data on the importance of play and pleasure in the lives of people with mental illness. We conclude by considering briefly the implications of this research for clinical practice.

Peer support among adults with serious mental illness: a report from the field.

Peer support is based on the belief that people who have faced, endured, and overcome adversity can offer useful support, encouragement, hope, and perhaps mentorship to others facing similar situations. While this belief is well accepted for many conditions, such as addiction, trauma, or cancer, stigma and stereotypes about mental illness have impeded attempts on the part of people in recovery to offer such supports within the mental health system. Beginning in the early 1990s with programs that deployed people with mental illness to provide conventional services such as case management, opportunities for the provision and receipt of peer support within the mental health system have proliferated rapidly across the country as part of the emerging recovery movement. This article defines peer support as a form of mental health care and reviews data from 4 randomized controlled trials, which demonstrated few differences between the outcomes of conventional care when provided by peers versus non-peers. We then consider what, if any, unique contributions can be made by virtue of a person's history of serious mental illness and recovery and review beginning efforts to identify and evaluate these potential valued-added components of care. We conclude by suggesting that peer support is still early in its development as a form of mental health service provision and encourage further exploration and evaluation of this promising, if yet unproven, practice.

Recovering the self in schizophrenia: an integrative review of qualitative studies.

In this paper we review qualitative research on recovery from schizophrenia and summarize how persons' daily activities and experiences reflect mechanisms of recovery of the self. We begin by describing examples of persons' daily activities, suggesting that they have in common a stance labeled by E. Corin (1990) as positive withdrawal, representing negotiation of distance from the social milieu. We note that positive withdrawal may foster the creation of larger life frames, representing broad mechanisms through which to reconsider and ultimately recover a durable sense of self. We suggest that these mechanisms are not specific to people with schizophrenia, and briefly discuss implications of these ideas for models of outpatient treatment.

Violent victimization of persons with co-occurring psychiatric and substance use disorders.

OBJECTIVE: This study examined the frequency with which persons in the community with psychiatric disorders, substance use disorders, and both types of disorders are victims of violence. METHODS: The relationship between diagnosis, gender, and victimization over a one-year period was examined in two cross-sectional data sets, one drawn from a study of adaptation to community life of persons with severe mental illness in Connecticut (N=109) and the other drawn from assessments made by caseworkers in a Connecticut outreach project for persons with psychiatric and substance use disorders (N=197). Analysis of variance was used to evaluate the frequency of victimization across diagnostic categories in each data set. RESULTS: People with co-occurring psychiatric and substance use disorders had significantly more episodes of victimization than those with either a psychiatric or a substance use disorder only. Gender was not associated with victimization. Qualitative data from focus groups indicated that social isolation and cognitive deficits leading to poor judgment about whom to trust may leave people with serious mental illness vulnerable to drug dealers. CONCLUSIONS: Social environmental mechanisms, such as exploitation by drug dealers, may play an important role in maintaining victimization among persons with co-occurring disorders.

An action model of socially disruptive behaviors committed by persons with severe mental illness: the role of self-reported childhood abuse and suspiciousness-hostility.

Espousing an Action Theory approach (Brandstadter, 1998; Lerner, 1982), the authors hypothesized that socially disruptive behaviors committed by people with severe mental illness will be at least partly influenced by incidents of childhood sexual and physical abuse. They further hypothesized that this effect of child abuse on disruptive behaviors in severe mental illness will be mediated by patients' suspiciousness and hostility. Structural equation modeling analyses conducted on data collected from 109 people with severe mental illness provided support for this mediating model. Our results encourage further exploration of the role of childhood maltreatment in the adaptation of people with severe mental illness.