Leslie Malchy

Life with jib: A snapshot of street youth's use of crystal methamphetamine

Crystal methamphetamine (CM) is a psychoactive form of methamphetamine whose effects include euphoria, alertness, restlessness, feelings of endless energy, sleep deprivation, depression, paranoia, acute psychosis, and malnutrition. CM use among street-involved youth is high, yet little is known about their patterns of use, the side effects they experience, and the ways in which they manage their drug use and survive on the streets. We undertook a small qualitative study among inner-city, street-involved youth to explore the social context of their CM use. Semi-structured interviews were conducted with twelve youth. Data were analyzed using thematic analysis and four key themes were identified: Patterns of Jib Use, Reasons for Using Jib, Downside of Using, and Managing Jib Use. Each theme revealed interrelationships between drug use and street-involvement. The youth used CM to stay awake to protect belongings, to enhance social interaction, to cope with negative emotions, and as an alternative to psychiatric medications. The negative consequences of CM use included deteriorating physical and mental health, exploitation, isolation, and physical harm. These youth were knowledgeable about their drug use and capable of creatively adapting to many of the related consequences. Social service agencies and health care professionals were not identified as helpful in managing their drug use and its side effects. Although the sample size was small, this data gives insight for policy and program planning aimed at providing treatment and support for street-involved youth using CM.

In the shadow of a new smoke free policy: A discourse analysis of health care providers' engagement in tobacco control in community mental health

BackgroundThe prevalence of tobacco use among individuals with mental illness remains a serious public health concern. Tobacco control has received little attention in community mental health despite the fact that many individuals with mental illness are heavy smokers and experience undue tobacco-related health consequences.MethodsThis qualitative study used methods of discourse analysis to examine the perceptions of health care providers, both professionals and paraprofessionals, in relation to their roles in tobacco control in the community mental health system. Tobacco control is best conceptualised as a suite of policies and practices directed at supporting smoke free premises, smoking cessation counselling and limiting access to tobacco products. The study took place following the establishment of a new policy that restricted tobacco smoking inside all mental health facilities and on their grounds. Ninety one health care providers participated in open-ended interviews in which they described their role in tobacco control. The interview data were analyzed discursively by asking questions such as: what assumptions underlie what is being said about tobacco?ResultsFive separate yet overlapping discursive frames were identified in which providers described their roles. Managing a smoke free environment emphasised the need to police and monitor the smoke free environment. Tobacco is therapeutic was a discourse that underscored the putative value of smoking for clients. Tobacco use is an individual choice located the decision to smoke with individual clients thereby negating a role in tobacco control for providers. Its someone elses role was a discourse that placed responsibility for tobacco control with others. Finally, the discourse of tobacco control as health promotion located tobacco control in a range of activities that are used to support the health of clients.ConclusionsThis study provides insights into the complex factors that shape tobacco control practices in the mental health field and reinforces the need to see practice change as a matter that extends beyond the individual. The study findings highlight discourses structured by power and powerlessness in environments in which health care providers are both imposing and resisting the smoke free policy.

Facilitating Knowledge Translation in the “Real World” of Community Psychiatry

BACKGROUND: Tobacco use disproportionately affects the well-being of individuals with mental illness. In community psychiatric settings, there are culturally embedded attitudes and behaviors regarding smoking that enable practitioners to remain ambivalent about their clients’ tobacco use. OBJECTIVES: Given these cultural norms, the authors aimed to introduce evidence-informed smoking cessation interventions to a variety of interdisciplinary mental health care providers by using an innovative approach to knowledge translation. DESIGN: The authors used a case study design in which six community psychiatric settings were targeted. The organizational culture related to smoking was examined at each site before tailored tobacco reduction interventions were delivered. The study design was guided by the knowledge-to-action (KTA) process and two supplementary approaches to change: motivational interviewing (MI) and appreciative inquiry (AI). RESULTS/CONCLUSIONS: The principles of the KTA process, MI, and AI helped the authors to meaningfully engage with practice groups and change the organizational culture surrounding tobacco use in several community psychiatric settings.

Correlates of secondhand tobacco smoke exposure among persons with severe and persistent mental illness (SPMI) accessing community mental health services.

To examine the correlates of secondhand tobacco smoke (SHS) exposure in a sample of individuals with severe and persistent mental illness (SPMI) accessing community mental health services. Cross-sectional data were collected from a voluntary sample of 788 individuals with SPMI. Nonsmokers were more likely to be exposed on the street or at a bus stop, in a park or public place; whereas smokers were more likely to report SHS exposure where they lived and at their friend’s homes. In a multivariate model, only number of acquaintances who smoked and the number of sources of SHS exposure remained significantly associated with perceived frequency of SHS exposure when accounting for other correlates. There is a need for the enactment and enforcement of policies to curtail SHS exposure in outdoor, public, settings. Future research will be necessary to better understand the extent and impact of SHS exposure in this population.

This is the embodiment of empowerment: use of forum theatre to address tobacco use in community psychiatry

Involvement in theatre has become an accessible avenue for individuals within the psychiatric system to dispel myths which surround their lived experiences and to actively create representations of themselves. Since practicing effective research knowledge translation to address tobacco within the context of mental health is emotionally charged, it must be approached not only with care and attention but also with creativity and skill. Interactive or “Forum” Theatre is a powerful tool to address sources of oppression for vulnerable groups and emerging evidence validates its use specifically as a method of knowledge translation. The objective of this current project was to engage in participatory dialogue through the use of forum theatre with individuals living with mental illness and with those who provide them services to contribute to creative strategies for behaviour change and to increase capacity building to address tobacco use within community psychiatry.