New forms of outreach in community psychiatry: a report from the field.
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Community Mental Health Services↗
Biomedical subjects
Larry Davidson
Publications and source records attributed to Larry Davidson.
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.
Adult↗
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.
Adolescent↗
"It's like being in another world": demonstrating the benefits of therapeutic horseback riding for individuals with psychiatric disability.
Five adults with longstanding histories of psychiatric disabilities were recruited for a ten-week therapeutic horseback riding program. Individuals learned basic riding skills and had the opportunity to bond with a horse. In addition, the riders participated in a post-riding process group that used artistic and creative exercises to promote individual expression. By the end often weeks, the riders reported success in learning basic horsemanship and, in doing so, also reported additional psychosocial benefits, including an augmented sense of self-efficacy and self-esteem. In sum, this adjunctive therapy can facilitate the recovery process.
Female↗
The integration of treatment and rehabilitation in psychiatric practice and services: a case study of a community mental health center.
After briefly reviewing the relationship of psychosocial rehabilitation to psychiatric practice, the authors recommend a renewed commitment of psychiatrists to bridge and integrate psychiatric treatment with psychosocial rehabilitation in practice and in the organization of services. They use the case example of an urban, community mental health center to illustrate a strategy for achieving greater integration of these two, relatively independent fields of professional practice. The Center's strategy for integration includes (1) center-wide planning, (2) structuring the medical staff office to support the task of integration, (3) establishing a model of practice and principles of care that supports both domains of intervention, (4) educating medical staff about psychosocial rehabilitation, (5) inter-disciplinary team building, including a definition and discussion of professional roles, (6) expanding services research on psychosocial rehabilitation, and (7) advocating in alliance with rehabilitation colleagues for expanded psychosocial rehabilitation services and their integration with treatment. By taking initiative to forward the integration of treatment and rehabilitation, psychiatrists better serve seriously ill patients and more effectively define their own work and roles.
Combined Modality Therapy↗
Engaging persons with substance use disorders: lessons from homeless outreach.
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Assertiveness↗
Panic attacks in psychosis.
OBJECTIVE: To determine the prevalence, psychiatric comorbidity and suicidal ideation associated with co-occurring non-affective psychosis and panic attacks, compared with non-affective psychosis without panic attacks, in the general population. METHOD: Data were drawn from the National Comorbidity Survey (n = 8098). Statistical analyses were used to identify differences in sociodemographic characteristics, psychiatric comorbidity, suicidal ideation, and familial psychopathology between those with non-affective psychoses with and without panic, as well as to identify correlates of non-affective psychosis and panic. RESULTS: Co-occurring panic attacks and non-affective psychosis, compared with non-affective psychosis without panic, was associated with elevated psychiatric comorbidity and increased odds of suicidal ideation. CONCLUSION: Consistent with clinical findings, these data suggest that panic attacks commonly co-occur with psychosis in the community. Results indicate that the co-occurrence of panic and psychosis is associated with increased likelihood of psychiatric comorbidity and suicidality. These findings need replication.
Adolescent↗
Fathers with serious mental illnesses: a neglected group.
In recent years, policy makers, researchers, and practitioners alike have come to recognize how the traditional emphasis on mothers has overshadowed the equally critical contribution of fathers to child development and family life. In spite of this growing recognition of the importance of fathers, the need to better understand and support fathers with serious mental illnesses (SMI) has received little attention within mental health, public welfare, child protection, or criminal justice systems. In an effort to counter the continuing neglect of fathers with SMI, this paper provides an overview of the scant existing research focusing on fathers with SMI and sets forth a series of recommendations highlighting the need for greater inclusion of fathers in future research and ways to support men with SMI in their role as parents.
Child↗
Understanding and evaluating qualitative research.
Qualitative research aims to address questions concerned with developing an understanding of the meaning and experience dimensions of humans' lives and social worlds. Central to good qualitative research is whether the research participants' subjective meanings, actions and social contexts, as understood by them, are illuminated. This paper aims to provide beginning researchers, and those unfamiliar with qualitative research, with an orientation to the principles that inform the evaluation of the design, conduct, findings and interpretation of qualitative research. It orients the reader to two philosophical perspectives, the interpretive and critical research paradigms, which underpin both the qualitative research methodologies most often used in mental health research, and how qualitative research is evaluated. Criteria for evaluating quality are interconnected with standards for ethics in qualitative research. They include principles for good practice in the conduct of qualitative research, and for trustworthiness in the interpretation of qualitative data. The paper reviews these criteria, and discusses how they may be used to evaluate qualitative research presented in research reports. These principles also offer some guidance about the conduct of sound qualitative research for the beginner qualitative researcher.
Comprehension↗
The Connecticut Mental Health Center Patient Profile Project: application of a service needs index.
This article describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center, a statefunded agency that provides comprehensive clinical and rehabilitative services to persons with mental illness. Also described is how this information guided management decisions in both caseload distribution and clinical service development. This "Patient Profile Project" was informed by research principles which view evaluation as continual, rather than terminal activity that involves key stakeholders from all levels within the mental health system of care and makes maximum use of data in ongoing performance improvement initiatives. The service-need index that the project produced represents our first efforts to accurately capture service need and use it in clinical decision making. This review of the Connecticut Mental Health Center Patient Profile Project illustrates the utility of a continuous evaluation system in promoting improvements in a large mental health treatment system.
Adult↗
The roles of behavioral health professionals in class action litigation.
Class action suits frequently have been used as a strategy for improving the quality of mental health care. Psychiatrists, psychologists, and professionals from related disciplines have been involved in these suits in different roles. This article presents and discusses case examples of these roles, which include the expert witness, court-appointed expert, consulting expert, monitor, special master, receiver, advocate, amicus curiae, plaintiff, and defendant. The authors caution against assuming dual roles and argue that professionals, before beginning to participate in this complex arena, should clarify their functional responsibilities, the legal basis of their involvement, and the ethics principles that will guide their actions.
Ethics, Professional↗
The relationship between anxiety and substance use disorders among individuals with severe affective disorders.
We sought to determine the association between anxiety disorders and substance use disorders among patients with severe affective disorders in a community-based outpatient treatment program. Two hundred sixty participants in a supported socialization program were assessed using the Structured Clinical Interview for DSM-III-R (SCID). Multivariate logistic regression analyses were used to determine the relationship between anxiety disorders and alcohol and substance use disorders among patients with severe and persistent affective disorders (i.e., major depression and bipolar disorder). Among patients with severe and persistent affective disorders, cocaine (odds ratio [OR] = 5.9 [1.4, 24.6]), stimulant (OR = 5.1 [1.2, 20.9]), sedative (OR = 5.4 [1.2, 24.7]), and opioid use disorders (OR = 13.9 [1.4, 138.7]) were significantly more common among those with, compared with those without, anxiety disorders. This association persisted after adjusting for differences in sociodemographic characteristics and comorbid psychotic disorders. Significant associations between panic attacks, social phobia, specific phobia, and obsessive-compulsive disorder (OCD) and specific substance use disorders were also evident. These findings are consistent with and extend previous results by documenting an association between anxiety disorders and substance use disorders, independent of comorbid psychotic disorders among patients in a outpatient psychiatric rehabilitation program. These data highlight the prevalence of comorbid anxiety disorders, a potentially undetected and therefore undertreated problem, among patients with severe affective disorders and substance use comorbidity. Future work is needed to determine the nature of this association and to determine whether treatment of one prevents onset of the other.
Anxiety Disorders↗