David Sells

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 studys limitations, findings suggest that use of peer mentors is a promising intervention for reducing recurrent psychiatric hospitalizations for patients at risk of readmission.

Play, Pleasure, and Other Positive Life Events: "Non-Specific" Factors in Recovery from Mental Illness?

Abstract 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 persons 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.

Trauma and adaptation in Severe Mental illness: The role of self-reported abuse and exposure to community violence

ABSTRACT The authors examined the role of self-reported physical and/or sexual abuse and recent exposure to community violence on three adaptation outcomes in Severe Mental Illness (SMI): psychotic symptoms, demoralization, and substance abuse. One hundred and nine (109) individuals with SMI were administered an extensive protocol that included the pertinent variables. Structural Equation Modeling analyses indicated that abuse predicted psychotic symptoms and demoralization, whereas exposure to community violence predicted substance abuse. These findings point to different possible trauma-adaptation configurations, and suggest that both past and present trauma complicates the adaptation of people with SMI.

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.

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.

Connecting criminal justice, mental health, and family support for better delivery of human services

The United States continues to struggle with the world’s highest incarceration rates (Drucker 2013), a mental health care system that has been described as ‘‘in shambles’’ (Frank and Glied 2006), and a social safety net that is often unable to reach the most vulnerable (Bitler et al. 2017). In the richest and most established democracy in the world, we know that this is not due to a lack of wealth or of institutions. Rather, we see assert here that the difference may be a matter of approach. To illustrate this, we present here an approach that ‘‘The Connection’’ has employed in the U.S. state of Connecticut. The Connection is a large, statewide agency of 600 staff and 45 residential and out-client programs providing services in the areas of community justice, behavioral health, and family and housing support. Unlike most agencies, it provides all these services under one rubric, which forces it not only to coordinate areas that are usually separated through specialization and sometimes opposing philosophies, but also to find common root causes that involve a client in these systems in the first place. Through these challenges, not only has The Connection been able to survive, but also maintained flexibility at a time when large-scale service organizations are suffering from rigid bureaucracies, has expanded in size and in budget multifold at a time when most are scaling down, and has filled critical service gaps for the state, providing for some of the most high-risk, stigmatized, or vulnerable populations. How is this possible? We hope to present here a brief summary of what we know about the agency (Please see Ethical statement; a list of independent evaluations are available upon request), in the hopes that it can inform practices elsewhere within the United States and abroad. First and foremost, a unique character of The Connection is that it insists on a human approach, no longer how large it becomes. Far from being non-descriptive or irrelevant, this philosophical orientation composes the core of its operational principles. Addressing the needs of individuals and families as paramount leads staff to draw upon the vast resources of the agency, rather than to match the client with a branch of services one ‘‘belongs to’’—and thus restricting the client to that domain. Secondly, being personrather than system-centered, it has encouraged creative adaptation over bureaucracy with growth. Rather than becoming more rigid with size, The Connection has incorporated flexibility and ‘‘humanity’’ through some key practices: it has maintained a ‘‘small programs’’ culture by allowing its individual program directors considerable control; it has encouraged creative ideas at the grounds level, where practitioners and clinicians are likely to know best what the needs are; and it has actively worked to bring together the individual programs within the larger ecology of the agency so as to share resources. This approach is ingrained in the institutional culture through ongoing training programs for staff. The main conceptual framework consists of: trauma-informed care (active listening and empathic questioning techniques), citizenship-based case management (validation as citizens with dignity and responsibility), and peer provider programs (active participation of those who have overcome similar challenges). By assessing the effectiveness of its programs, The Connection has been a pioneer in conducting concurrent research, far before the practice became widespread, and over more than 20 years has built partnerships with the University of Connecticut, Wesleyan University, Yale University, Central Connecticut State University, the University of New Haven, and other This editorial is part of the special issue ‘‘Violence, Justice, and Health: Implications for a Multisectoral Collaboration’’.