Carolyn Doughty

Can Consumer-Led Mental Health Services be Equally Effective? An Integrative Review of CLMH Services in High-Income Countries

This study examined the evidence from controlled studies for the effectiveness of consumer-led mental health services. Following an extensive search of material published in English from 1980, predefined inclusion criteria were systematically applied to research articles that compared a consumer-led mental health service to a traditional mental health service. A total of 29 eligible studies were appraised; all of them were conducted in high-income countries. Overall consumer-led services reported equally positive outcomes for their clients as traditional services, particularly for practical outcomes such as employment or living arrangements, and in reducing hospitalizations and thus the cost of services. Involving consumers in service delivery appears to provide employment opportunities and be beneficial overall for the consumer-staff members and the service. Despite growing evidence of effectiveness, barriers such as underfunding continue to limit the use and evaluation of consumer-led services. Future studies need to adopt more uniform definitions and prioritize the inclusion of recovery oriented outcome measures.

Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder

The variable expression of autism over the lifespan is likely to lead to different symptoms and support requirements, and to distinct responses to pharmacotherapy treatment, in older patients compared to children. This systematic review considers the effectiveness of pharmacological treatment in managing autism spectrum disorder in adolescents and adults. Following a comprehensive search of literature published in English from 1980, methodological criteria were applied to identify studies designed to reliably assess treatment effectiveness. Only five double-blind, randomized controlled trials were eligible for appraisal. All had small sample sizes (mean = 30) and brief treatment duration of no more than 12 weeks. The paucity of trials and their methodological limitations means that there is only preliminary evidence about the short-term effectiveness of a few drug treatments for this age group. There was also a lack of reliable data reported on drug safety profiles. Methodological challenges and directions for future research are discussed.

The Wellness Recovery Action Plan (WRAP): workshop evaluation

Objective: This study evaluated the delivery of a series of workshops on mental health recovery. The aims were to determine if the workshops changed participants’ attitudes and knowledge about recovery, if there were any differences in views between consumers and health professionals of mental health services, and how the delivery and content of the program could be improved. Methods: A total of 187 consumers and health professionals from mental health services attended a workshop based on the Wellness Recovery Action Plan (WRAP). Questionnaires were administered before and after the workshop. Results: There was a significant change in total attitudes and knowledge about recovery (p<0.001) in the expected direction, with no differences between consumers and health professionals. The majority of participants found the workshop useful, and the majority of comments were positive. Conclusions: This study provides preliminary support for the use of WRAP to change consumers’ and mental health professionals’ knowledge and attitudes about recovery.

A consensus statement for safety monitoring guidelines of treatments for major depressive disorder

Objective: This paper aims to present an overview of screening and safety considerations for the treatment of clinical depressive disorders and make recommendations for safety monitoring. Method: Data were sourced by a literature search using MEDLINE and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content. Results: Screening and monitoring can detect medical causes of depression. Specific adverse effects associated with antidepressant treatments may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment. Conclusion: The adoption of safety monitoring guidelines when treating clinical depression is likely to improve overall physical health status and treatment outcome. It is important to implement these guidelines in the routine management of clinical depression.

'Having Those Conversations': The Politics of Risk in Peer Support Practice

Abstract Peer support is a fast growing type of service provision within the mental health sector. This study draws on interviews with peer supporters and peer support managers to explore the ways that risks of violence, suicide and self-harm are managed within peer support settings in Aotearoa New Zealand. Drawing on Nikolas Rose and other theorists, who define risk thinking as an attempt to ‘discipline uncertainty’, we argue that the philosophy of peer support is in tension with a ‘risk consciousness’ because it sees crisis as a learning opportunity. We contend that peer supporters are pulled towards the ‘risk consciousness’, which pervades the mental health sector, and that they address this by managing risk in various ways. Finally, we show that peer supporters challenge this risk consciousness by working with risk through a philosophy of engagement and relationship. As peer support becomes more integrated into the wider health system, the challenge will be to continue the development of risk practices which work within a strong peer support philosophy.

Care, empowerment and self-determination in the practice of peer support

The concept of ‘care’ has been fraught with negative connotations within the disability movement; the concepts of empowerment, choice and control have been developed as alternatives. The peer-support movement in the mental health sector draws from this tradition, and is uncomfortable with the provision of care. Drawing on the feminist ethic of care, we will argue in this paper that ‘care’ – in the sense of caring about, rather than caring for – should be seen as fundamental within peer support. The practice of peer support evidences a kind of ‘care’ that does involve some interdependence, and taking of ‘responsibility’. The challenge is to make this a ‘responsibility towards’, rather than a ‘responsibility for’. If this is successfully achieved, care can indeed become acknowledged as part of ‘standard peer support’, and the basis for the development of autonomy and self-determination.

O-10 - Safety monitoring guidelines for treatments for major depressive disorder

Introduction Antidepressants are amongst the most commonly prescribed classes of drugs and their use continues to grow. Adverse outcomes are part of the landscape in prescribing medications and therefore management of safety issues need to be an integral part of practice. Objectives We have developed consensus guidelines for safety monitoring with antidepressant treatments. Aims To present an overview of screening and safety considerations for pharmacotherapy of clinical depressive disorders and make recommendations for safety monitoring. Methods Data were sourced by a literature search using Medline and a manual search of scientific journals to identify relevant articles. Draft guidelines were prepared and serially revised in an iterative manner until all co-authors gave final approval of content. Results A guidelines document was produced after approval by all 19 co-authors. The final document gives guidance on; the decision to treat, baseline screening prior to commencement of treatment, and ongoing monitoring during antidepressant treatment. The guidelines state or reference screening protocols that may detect medical causes of depression as well as screening and monitoring protocols to investigate specific adverse effects associated with antidepressant treatments that may be reduced or identified earlier by baseline screening and agent-specific monitoring after commencing treatment. Conclusions The implementation of safety monitoring guidelines for treatment of clinical depression may significantly improve outcome, by improving a patients overall physical health status.