Linda Chafetz

Clinical trial of wellness training: health promotion for severely mentally ill adults.

This randomized controlled trial examined benefits of adding active health promotion to basic primary care (BPC) services for SMI adults. It compared BPC with BPC plus wellness training (WT), a 12 months intervention promoting individual skills in self-management. Three hundred nine participants enrolled during short-term residential treatment completed baseline assessments and were assigned to treatment groups, before discharge. Outcomes of perceived health status (SF-36), global assessment of function, and ratings of self-efficacy were assessed at follow-up interviews at 6, 12, and 18 months. The intent-to-treat analysis employed multilevel regression to examine differences by group on outcomes across time, controlling for health related covariates. The WT group showed significantly better outcomes on the SF-36 physical functioning and general health scales. Findings affirm ability of SMI adults to benefit from active health promotion.

The experience of severe mental illness: A life history approach

In this report, severely mentally ill adults describe their experiences of long-term illness. Forty-three research participants completed Life Chart Interviews covering their personal history since the onset of their psychiatric disorder. Participants appeared to be generally reliable informants on their treatment histories. They indicated that individual learning and personal choices influenced the course of the psychiatric disorder over time, including decisions about use of treatment and environmental support. These results support the value of life-context approach to research on severe mental illness.

Psychological morbidity of Thai families of a person with schizophrenia

The paper presents data on families of a person with schizophrenia in rural Thailand, using the resiliency model of family stress, adjustment, and adaptation. The aim is to assess the impact of family factors on psychological morbidity of the mothers and relatives of a person with schizophrenia. One hundred and eight Thai families were interviewed based on family assessment instruments. Multiple regression analysis was performed. The findings suggest that in a stable stage of illness, other stresses of family life may have stronger impact on psychological status of family members, than the illness. Implications for clinical nurses and researchers are presented.

Development of integrated mental health care: Critical workforce competencies

In integrated care, a person will have his or her medical and behavioral health needs addressed within one health care system. Support for integrated models has grown with the increasing awareness of how the medical comorbidities of individuals with serious mental illness contribute to their morbidity and mortality, the prevalence of mental health problems in the general population, and the mental health issues among those with chronic medical problems. The enactment of effective integrated care will demand developing clinicians who are trained to work with mental health needs at various levels of intensity, who are capable of addressing complex comorbidities, and who operate from a person-centered approach to care. In this light we argue that given their unique skill set and clinical training, Psychiatric-Mental Health Advanced Practice Nurses could play a critical role in integrated care and present policy recommendations which support the development of the Psychiatric-Mental Health Advanced Practice Nurses role in such models.

FACTORS ASSOCIATED WITH RESIDENTIAL PLACEMENT IN AN ASSERTIVE COMMUNITY TREATMENT PROGRAM

Assertive community treatment (ACT) programs originated to meet the needs of the severely mentally ill (SMI) for multiple psychosocial supports necessary for community living. Housing has been prominent among these needs and research to date on ACT programs has addressed residential outcomes, principally reduced homelessness and maintenance in some form of stable housing. However, limited studies have examined variables that might predict particular types of residential placements, which range from unsupervised to highly structured environments. The purpose of this study was to identify factors related to residential placement for the subjects in a model ACT program. Of multiple variables assessed, two were significantly related to residential placement. Chronic respiratory illness was strongly associated with placement in supervised group homes. Team assignment was associated with placement, with clients in one of three teams significantly more likely to live more independently. Clients assigned to this team showed higher psychosocial functioning than others in terms of functional ratings on the Multnomah Community Ability Scale. However, higher function alone was not significantly associated with placement, suggesting a role for clinical judgement and a need for future research in this area.

Exploring the Impact of Race on Mental Health Service Utilization Among African Americans and Whites With Severe Mental Illness

BACKGROUND: Disparities among African Americans and Whites with severe mental illness have been identified in numerous studies. Yet it remains unknown if disparities are associated with race or other vulnerabilities common to this population. OBJECTIVES: This study used the Behavioral Model for Vulnerable Populations to examine mental health service utilization among 155 African Americans and Whites with severe mental illness for 12 months after discharge from a residential crisis program. DESIGN: This cross-sectional study was a secondary analysis of data from a randomized trial. RESULTS: Race did not emerge as a significant predictor of mental health service utilization. Factors associated with frequency of service use were diagnosis, age, drug use, gender, health benefit status, and enrollment in an outpatient mental health program. CONCLUSION: It is possible that the geographic location of the study, equal access to services, and equal rates of substance use between racial groups explain the lack of racial differences found in this sample.

Eligibility, Recruitment, and Retention of African Americans with Severe Mental Illness in Community Research

Data that addresses severely mentally ill (SMI) African Americans (AAs) likelihood to participate in clinical research is limited. This study’s purpose was to determine if differences exist between races regarding eligibility, recruitment, and retention in a community-based clinical trial. The sample included 293 participants. Data sources included clinical records and interviews. Logistic regression was used for analysis. AAs were as likely to participate and to complete followup interviews as Whites. In contrast to studies about non-mentally ill AAs, AAs with SMI appeared to be as willing to consent to and to remain in clinical research studies as Whites.

Older Adults with Schizophrenia Finding a Place to Belong

Older adults with schizophrenia experience a high prevalence of comorbid conditions. The perspective of older adults with schizophrenia about their physical health has not been considered as a contributing factor. This paper presents findings from a grounded theory study that explored this perspective among 28 older adults with schizophrenia. Analyses revealed that finding a sense of belonging supported feeling physically healthy. A sense of connection with others and a physical place were associated with supporting a sense of belonging. Awareness of the facilitators of and barriers to finding a place to belong is key to improving the physical health of this vulnerable population.

Methods for studying course of illness with severely mentally ill adults.

This study examined methods for obtaining course of illness data on adults who are severely mentally ill. A convenience sample (N = 60) was recruited within 4 programs serving different subgroups of adults with severe mental illness. Forty-three participants were able to complete follow-up interviews, using a life chart format to report on personal history in the domains of housing, employment, finances, psychiatric service utilization, health problems, use of psychotropic medication, drug and alcohol use, social relationships, and other major life events. Corresponding information was abstracted from treatment records and examined for concordance with self-reports. Results showed distinct areas of concordance, including recent (1 year) life events, psychiatric care, psychotropic medications, and use of alcohol. Areas of disagreement included legal problems, illicit drug use, and general health. With multiple data sources, it is possible to involve a range of adults with severe mental illness in research and to incorporate their knowledge into course of illness studies.

Differences in substance-related risk behavior between dual and triple diagnosed severely mentally ill adults

OBJECTIVES: The purpose of this study was to determine if differences exist between adults with dual and triple diagnoses with regard to substance-related risk behaviors. METHODS: This secondary analysis was a cross-sectional study. There were 252 subjects with dual and triple diagnoses recruited from residential crisis programs in San Francisco. Using descriptive and logistic regression analyses, subjects in the two groups were compared with regard to demographic data, types of substances, and routes of administration used in the previous 30 days to determine risk for exposure and/or transmission of HIV/HCV. RESULTS: When compared to the dual diagnosis group, subjects with triple diagnoses were four times more likely to have engaged in IDU (p=.001) and 2.6 times more likely to use amphetamines (p=.05). They also reported using more types of substances over the lifetime (p<.0001). But with regard to other risk behaviors such as alcohol use to intoxication and cocaine/crack use, there were no significant differences. CONCLUSION: Though many substance-related risk behaviors occurred in both groups, adults with triple diagnoses were more likely to engage in IDU, amphetamine use, and to use more types of substances over the lifetime. This information has the potential to inform interventions that might prevent/reduce substance-related risk in this population.