BACKGROUNDS. A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on health and wellbeing, there is a lack of research regarding the model called the Psychiatric Rehabilitation Approach from Boston University (BPR).
The aim was to investigate the outcome of the BPR intervention regarding changes in life situation, use of healthcare services, quality of life, health, psychosocial functioning and empowerment.
The study has a prospective longitudinal design and the setting was seven mental health services who worked with the BPR in the county of Halland in Sweden. In total, 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments.
The most significant finding was an improved psychosocial functioning at the follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up. There were significant differences with regard to health, empowerment, quality of life and psychosocial functioning for those who reported that they had mainly/completely had achieved their self-formulated rehabilitation goals compared to those who reported that they only had to a small extent or not at all reached their goals.
Our results indicate that the BPR approach has impact on clients' health, empowerment, quality of life and in particular concerning psychosocial functioning.
The present study investigates attitudes towards aspects of health promotion in mental health services, as rated by patients and staff. The aim of the study was to investigate similarities and differences in attitudes towards health promotion interventions among patients and staff in mental health services, using a newly developed questionnaire, the Health Promotion Intervention Questionnaire (HPIQ). The study has a cross-sectional design and a sample of 141 patients and 140 staff were recruited to the study. The response rate was 59% for the patients and 50% for the staff. The participants were asked to rate the attitudes of the 19 items included in the HPIQ. The result showed that patients and staff in some cases share similar attitudes regarding aspects of health promotion intervention. According to both groups, empowerment is the most important intervention in health promotion. Significant differences between the ratings of patients and staff appeared regarding all subscales of HPIQ. Patients rated alliance and educational support significantly higher than staff and staff-rated empowerment and practical support significantly higher than patients. Based on these findings, it is of importance to meet patients' desire for information and knowledge in an interactive manner with an empowerment approach to promote health in mental health services.
The aim of the study was to examine the changes in attitudes towards mental illness after theoretical education and clinical placement among students from university programmes preparing for different kinds of health professions. Three different questionnaires were used, measuring the level of familiarity with mental illness and attitudes towards mental illness in general and towards specific mental illnesses. The data were collected on two occasions, before the theoretical course and after the completed clinical placement. The result showed that the attitudes toward mental illness in general had changed in a less stigmatising direction after the clinical placement. On the other hand, attitudes toward specific mental illnesses did not show any major changes. A conclusion is that the clinical placement included in the university programmes to some extent could affect attitudes in a de-stigmatizing direction, possibly because of the interaction with persons suffering from mental illness and experienced supervisors.
The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients' experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients' experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in "A sense of being in communion with self and others" theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients' ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required.
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Positive dimensions of mental health are strong protective factors against physical and mental illness in general population. A cross-sectional study including a randomly selected sample of 141 outpatients was performed to explore differences in patients' self-reported importance of elements of health and subjective experiences of health related to sociodemographic background variables. The examination of differences in self-reported importance of elements of health showed differences regarding gender, and the analyses of subjectively experienced health showed differences regarding age and diagnosis. Clinical interventions aiming at strengthening positive dimensions of health are required in community mental health services to meet the patients' individual needs of enhanced health.
Restricted mental health literacy and stigma are barriers to treatment of mental disorders. A Mental Health First Aid training program was tested for implementation in Sweden among employees in the public sector. The aim of the present qualitative study was to explore participants' experiences of the program in more depth, in conjunction with a randomized controlled study. Twenty four persons participated in a total of six focus groups 6-8 months after program participation. Data were analyzed using content analysis. The analysis resulted in five categories illustrating the participants' experiences of the course: increased awareness, knowledge and understanding; influence on attitude and approach; tool box and confidence; feedback on content and layout; and tangible examples of applied knowledge. The most central finding is the fruitfulness of the program's practical focus and use, the increased confidence and inclination to act following program participation, and the importance of experienced instructors.
National guidelines are released regularly, and professionals are expected to adopt and implement them. However, studies dealing with mental health-care professionals' views about guidelines are sparse. The aim of the present study was to highlight mental health-care staff's views on the Swedish national guidelines for 'psychosocial interventions for schizophrenia or schizophrenia-type symptoms' and their implementation. The study took place in the southeast parts of Sweden, and data were collected through five group interviews consisting of 16 professionals working either in the county council or in the municipalities. The transcribed text was analysed by content analysis, revealing two categories. The first category 'a challenge to the practice of care as known' reflected that the release of guidelines could be perceived as a challenge to prevailing care and culture. The second category 'anticipating change to come from above' mirrored views on how staff expected the implementation process to flow from top to bottom. To facilitate working in accordance with guidelines, we suggest that future guidelines should be accompanied by an implementation plan, where the educational needs of frontline staff are taken into account. There is also a need for policy makers and managers to assume responsibility in supporting the implementation of evidence-based practice.
Background Evidence suggests that mental health literacy among the public is low, and stigmatizing attitudes are widespread. So far the effects of anti-stigma campaigns are small, and studies demonstrate that negative attitudes have been quite stable through recent decades. Aims To investigate the relationships between mental health literacy, experience of mental illness and stigmatizing attitudes/social distance towards people with depression or psychosis. Methods A cross-sectional study in which staff members from public services in Sweden (n?=?1027) completed questionnaires covering demographic data, self-reported experience of mental illness, identification of a vignette for depression or psychosis, beliefs about helpful interventions for the illness presented in the vignette, and attitudes and social distance towards people with the illness. Results About 50% of participants could identify depression and less than 40% psychosis. A higher degree of mental health literacy was related to less stigma and social distance but mainly towards people with depression. A similar relationship was shown for having personal or family experience of mental illness and attitudes/social distance. Negative attitudes and social distance were significantly higher in all aspects measured towards a person with psychosis than a person with depression. Conclusions A higher degree of mental health literacy relates to more positive attitudes and less desire for social distance towards people with depression. The differences between depression and psychosis should be taken into account in anti-stigma interventions.
Lack of participation in the open labour market is highly prevalent for people with a mental illness across countries, and the proportion of people who get some kind of sickness benefit because of mental illness is steadily growing in Europe. Vocational rehabilitation through individual placement and support (IPS) has been shown to be effective and is evidence-based for people with severe mental illness. In Sweden, the method is used but not scientifically evaluated. The aim was to investigate vocational and nonvocational outcomes at a 1-year follow-up and the relationships between these outcomes, at two different sites in the north of Sweden. The participants were 65 men and women, mostly younger than 30 years of age and with a mental illness. Occupational situation, psychiatric symptoms, self-esteem, quality of life and psychosocial functioning were assessed. The vocational outcome during 1 year was that 25% of the participants were employed, and 14% were in education. Most of the participants moved from unemployment to work practice for a prolonged time. Participants in employment, education or work practice at follow-up showed higher satisfaction with their occupational situation than those without regular activities outside home. Among the participants in work practice, improvements in psychiatric symptoms and global functioning were identified. This attempt is the first to evaluate supported employment according to the IPS model for persons with mental illness applied in the Swedish welfare system. There is a need for a longer follow-up period to evaluate whether interventions such as further education and work practice actually will lead to real work.
The adoption of evidence-based guidelines within the mental health field has been slow. Changing inadequate practice is therefore a formidable challenge for mental health-care managers.
To explore decision-makers' attitudes and awareness regarding the national guidelines for psychosocial interventions targeting people with schizophrenia.
A questionnaire distributed by e-mail to 592 Swedish decision-makers was analysed using descriptive and comparative techniques.
Significantly more of the top-level mental health-care managers than politicians stated that they knew about the national guidelines (i.e. their release and content) and they considered the guidelines to be a good source of support for planning and allocating resources.
If those responsible for allocating resources (i.e. politicians) are unaware of the dissemination of national guidelines or their content, and they do not perceive the national guidelines to be a good source of support for planning and allocating resources, this is likely to have a negative influence on the remit of nurse managers as well as nursing practice.
Top-level mental health-care managers have a vital role to play in the implementation of national guidelines. However, our findings indicate that implementing national guidelines in practice could be virtually impossible without strategic government support.