Step-up, step-down mental health care service: evidence from Western Australia's first - a mixed-method cohort study.

BACKGROUND: Mental health Step-up, Step-down services (SUSD), also known as subacute services or Prevention and Recovery Services, have emerged to fill an identified gap between hospital-based inpatient care and clinical community-based mental health support. Evidence for the effectiveness of the SUSD service model is limited but growing. Accordingly, this study looked to add to the extant body of knowledge, by (i) assessing change outcomes in mental health and wellbeing, and predictors of these changes, for patients who accessed Western Australia's first SUSD service; and (ii) evaluating patients' satisfaction with service, and what patients value from their stay. METHODS: This was a mixed-method retrospective cohort study. Participants comprised 382 patients who accessed a 22-bed Mental Health SUSD facility and incurred 551 episodes of care during the 01/07/2014-30/06/2016 period. Patients' change outcomes in psychological distress, general self-efficacy, and work and social adjustment from service entry to service exit were analyzed using generalized linear modeling. Simple Pearson's correlation coefficients were calculated for preliminary assessment of the associations between patients' service satisfaction and their change outcomes. Qualitative outcomes that patients valued from their stay were analyzed thematically according to a semi-grounded theoretical approach. RESULTS: Significant improvements were observed in patients' self-reported psychological distress, self-efficacy, and work and social adjustment (all p < 0.0001). A strong and persistent baseline effect existed across the three measures. Older age, female gender, and having a dependent child in the same household were protective/enhancing factors for the patients' recovery. Satisfaction with service was high. Patients valued having the time and space to recuperate, gain insight, focus, and create changes in their lives. CONCLUSION: The encouraging findings, regarding both patients' change outcomes and satisfaction with service, support the value of the SUSD service model for patients with mental illnesses. Strengths and limitations were discussed; ensued recommendations were offered to both service providers and researchers to enhance the robustness of future research findings, to help inform more effective policy and funding decisions related to mental health care.

Feasibility of a Consumer Centred Tobacco Management intervention in Community Mental Health Services in Australia.

This study tested a new program for helping smokers with severe mental illness to reduce their tobacco use, together with determining the feasibility of such research in community mental health settings in Australia. Five Neami National sites trialled a Consumer Centred Tobacco Management program called Kick the Habit (n = 34). The intervention included two weeks of free Nicotine Replacement Therapy (patches only) but participants also used a variety of self-funded delivery types in addition or as an alternative to the subsidised nicotine patch. At the 3-month follow-up, Kick the Habit participants had reduced their number of daily cigarettes, dependency levels and average weekly expenditure on tobacco. Although a larger study is required, Kick the Habit represents a promising intervention for tobacco management in community mental health services. The challenges and lessons learnt for scaling up to a larger trial and integration into business-as-usual practice across multiple sites are discussed.

Active8: Promoting health beyond the absence of mental illness.

OBJECTIVE: We sought to understand and develop the critical elements of a program designed to promote physical health for people living with or experiencing mental illness. DESIGN: The study used a most significant change approach. Participants provided personal accounts of change, and these were analysed in a workshop with a range of stakeholders involved in program design and delivery. Core themes were identified to inform the development of the program. SETTING: The program is delivered by a community managed organisation in the South Eastern Illawarra region of New South Wales and the study took place in this setting. PARTICIPANTS: Participants included people who had accessed the Active8 program, staff who delivered the program, referrers and the funder of the program. MAIN OUTCOME MEASURES: Participants were invited to share stories of how the Active8 program had impacted them or the people they were supporting. RESULTS: Five key themes were identified as being critical to program success and development: (a) the right start at the right time; (b) a program that fits me; (c) health literacy leads to agency, action and change; (d) a chance to explore and establish healthy connections; and (e) change requires time, focus and ongoing support. CONCLUSION: Approaches that steer away from simple advice giving and towards empowering and motivating people in line with their individual needs, aspirations and social context show potential for enhancing health-behaviour change.

Better Health Choices: Feasability and preliminary effectiveness of a peer delivered healthy lifestyle intervention in a community mental health setting.

BACKGROUND: To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention. METHODS: The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National. RESULTS: Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable. CONCLUSIONS: Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted. STUDY REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550).

File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study.

BACKGROUND: Over the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework - the Collaborative Recovery Model could be sustained over time. METHOD: The study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier. RESULTS: The file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the 'Action Plan Review' audit item. CONCLUSIONS: A comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.

Health literacy in people living with mental illness: A latent profile analysis.

Health literacy comprises cognitive and social skills that enable people to understand health information and maintain good health. Research examining the health literacy of people living with mental illness is scarce. The aim of the present study was to identify distinct subgroups of health literacy in individuals attending mental health treatment and determine if profiles and health literacy levels differ from other populations accessing healthcare services and on health characteristics. Participants (N = 325) were attending Neami National Australia services. Participants completed the multidimensional Health Literacy Questionnaire. Latent profile analysis was conducted to identify health literacy profiles. Participants reported lowest health literacy scores in appraising health information, navigating the healthcare system, and finding good health information. Three health literacy profiles were identified; low (20.4%), moderate (61.3%), and high (18.3%). Compared to the other populations (i.e. private hospital patients, men with prostate cancer, older individuals with diabetes, general population, people attending substance dependence treatment), the current sample tended to have lower health literacy scores. The findings highlight the need to increase overall health literacy and consider an individualised approach to enhance specific health literacy domains.

Coherence between goals and therapeutic homework of clients engaging in recovery-oriented support.

OBJECTIVE: Our goal was to develop and pilot a methodology that could reliably identify therapeutic homework tasks that are coherent with the goals of individuals receiving mental health recovery support. METHOD: The content of goals and therapeutic homework tasks of 66 clients were classified using the Camberwell Assessment of Need Goal-Action Plan (CAN-GAP) taxonomy. Goal-homework pairs were considered coherent if the content of the homework and goal were both independently assigned the same content domain. RESULTS: The content of the goals and homework tasks were found to be highly coherent, with a 75% match in categories. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It is possible to simply, and reliably, determine whether the content of goals and homework tasks are coherent. Lower coherence would require support workers to spend more time making the connection between homework and goals more explicit. Future research should determine whether higher coherence leads to greater goal attainment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Consumer and staff perspectives of the implementation frequency and value of recovery and wellbeing oriented practices.

BACKGROUND: Despite advances in our understanding of what mental health systems and services can do to enhance recovery and wellbeing outcomes for people seeking support, there is limited evidence demonstrating that this body of work has translated successfully into mental health service practice. The Collaborative Recovery Model (CRM) is a practice framework that has been designed to support application of recovery and wellbeing oriented principles and practices within mental health service delivery. The aims of this study were to assess consumer and staff perceptions of implementation frequency during service engagement and the value of this approach for assisting recovery within a setting where the CRM approach had been adopted. METHODS: The setting was a large Australian community managed mental health organisation. The study involved a cross-sectional analysis of consumer (n = 116) and staff practitioner (n = 62) perspectives. A series of paired sample t-tests assessed for differences between consumer and staff perceptions of the: (i) importance of key practice elements for assisting recovery, and the (ii) frequency that key practice elements are utilised during engagement sessions. Spearman's r correlational analysis explored associations between importance, frequency and helpfulness of sessions. RESULTS: Key practice elements of the model were applied during service interactions at a high level and perceived by the majority of consumers and staff participants as being important or very important for assisting recovery. Significant moderate correlations were found between the extent that practice elements were valued and the level at which they were applied. Higher levels of implementation of CRM practices were associated with higher ratings of perceived session helpfulness. The strongest association was between 'encouragement to set tasks to complete between support visits' and perceived helpfulness. CONCLUSIONS: Consumer and staff responses revealed that the key practice elements of the CRM were frequently implemented during service engagement interactions and were seen as valuable for assisting recovery. The level of agreement between raters suggests firstly, that the key practice elements were apparent and able to be rated as occurring, and secondly that the CRM approach is seen as responsive to consumer needs. The results have implications for translating recovery and wellbeing oriented knowledge into mental health service practice.

Development of a structured interview schedule to assess stage of psychological recovery from enduring mental illness.

Abstract Objective. To develop a brief interview-based assessment tool, feasible for routine use in mental health service settings to measure an individual's stage of psychological recovery from an enduring mental illness. Method. Key indicators for each stage of psychological recovery were formulated according to the stages of psychological conceptual framework and an analysis of transcribed data wherein 17 consumer participants described their illness and recovery experiences. Upon development of the measure, Short Interview to assess Stages of Recovery (SIST-R), the instrument was evaluated by practitioners and consumers to examine its feasibility for use in mental health service settings. A pilot test with 18 mental health consumer participants compared results obtained by the SIST-R with those from an existing self-report stages of psychological recovery measure (STORI), a measure of psychological distress (K-10), and a measure of recovery (RAS). Results. Concordance between the SIST-R and the STORI was substantial (Somers' D = 0.61, P = 0.004). The mean scores from other recovery measures correspond with what could be theoretically expected across individual stages of recovery. Conclusion. This study contributes towards the strengthening of a recovery-oriented approach within clinical/mental health service settings with the development of an assessment tool that demonstrates potential clinical utility. There is a need to validate further the preliminary findings of this study.