Shalini Lal

E-Mental Health: A Rapid Review of the Literature

OBJECTIVE The authors conducted a review of the literature on e-mental health, including its applications, strengths, limitations, and evidence base. METHODS The rapid review approach, an emerging type of knowledge synthesis, was used in response to a request for information from policy makers. MEDLINE was searched from 2005 to 2010 by using relevant terms. The search was supplemented with a general Internet search and a search focused on key authors. RESULTS A total of 115 documents were reviewed: 94% were peer-reviewed articles, and 51% described primary research. Most of the research (76%) originated in the United States, Australia, or the Netherlands. The review identified e-mental health applications addressing four areas of mental health service delivery: information provision; screening, assessment, and monitoring; intervention; and social support. Currently, applications are most frequently aimed at adults with depression or anxiety disorders. Some interventions have demonstrated effectiveness in early trials. Many believe that e-mental health has enormous potential to address the gap between the identified need for services and the limited capacity and resources to provide conventional treatment. Strengths of e-mental health initiatives noted in the literature include improved accessibility, reduced costs (although start-up and research and development costs are necessary), flexibility in terms of standardization and personalization, interactivity, and consumer engagement. CONCLUSIONS E-mental health applications are proliferating and hold promise to expand access to care. Further discussion and research are needed on how to effectively incorporate e-mental health into service systems and to apply it to diverse populations.

A scoping review of the Photovoice method: implications for occupational therapy research.

Background. Photovoice is a participatory action research method combining photography and group work to give people an opportunity to record and reflect on their daily lives. Purpose. To review the use of Photovoice in health research and consider the implications for occupational therapy research. Methods. Literature review, guided by a scoping framework, reveals the purposes, rationales and populations with whom Photovoice has been used. Findings. From 351 documents retrieved, 191 original studies were surveyed; 68% were peer-reviewed. The majority of studies (76%) occurred within the public health domain and a smaller percentage (24%) with individuals experiencing a specific illness and/or disability, with very few (2%) documented in the occupational therapy literature. Implications. Photovoice provides a useful framework to apply a participant-centred research approach on occupational participation. It is important to consider and further examine ethical and methodological issues related to stigma, physical and cognitive capacities, mobility and technical accessibility related to using this method.

Preferences of Young Adults With First-Episode Psychosis for Receiving Specialized Mental Health Services Using Technology: A Survey Study

Background Despite the potential and interest of using technology for delivering specialized psychiatric services to young adults, surprisingly limited attention has been paid to systematically assess their perspectives in this regard. For example, limited knowledge exists on the extent to which young people receiving specialized services for a first-episode psychosis (FEP) are receptive to using new technologies as part of mental health care, and to which types of technology-enabled mental health interventions they are amenable to. Objective The purpose of this study is to assess the interest of young adults with FEP in using technology to receive mental health information, services, and supports. Methods This study uses a cross-sectional, descriptive survey design. A convenience sample of 67 participants between the ages of 18 and 35 were recruited from two specialized early intervention programs for psychosis. Interviewer-administered surveys were conducted between December 2013 and October 2014. Descriptive statistics are reported. Results Among the 67 respondents who completed the survey, the majority (85%, 57/67) agreed or strongly agreed with YouTube as a platform for mental health-related services and supports. The top five technology-enabled services that participants were amenable to were (1) information on medication (96%, 64/67); (2) information on education, career, and employment (93%, 62/67); (3) decision-making tools pertaining to treatment and recovery (93%, 62/67); (4) reminders for appointments via text messaging (93%, 62/67); and (5) information about mental health, psychosis, and recovery in general (91%, 61/67). The top self-reported barriers to seeking mental health information online were lack of knowledge on how to perform an Internet search (31%, 21/67) and the way information is presented online (27%, 18/67). Two thirds (67%; 45/67) reported being comfortable in online settings, and almost half (48%; 32/67) reported a preference for mixed formats when viewing mental health information online (eg, text, video, visual graphics). Conclusions Young people diagnosed with FEP express interest in using the Internet, social media, and mobile technologies for receiving mental health-related services. Increasing the awareness of young people in relation to various forms of technology-enabled mental health care warrants further attention. A consideration for future research is to obtain more in-depth knowledge on young people’s perspectives, which can help improve the design, development, and implementation of integrated technological health innovations within the delivery of specialized mental health care.

Prescribing Recovery as the New Mantra for Mental Health: Does One Prescription Serve All?

Background. “Recovery” is the new mantra for reforming the mental health system and occupational therapists have embraced the change. Purpose. To critically examine the concept of recovery across five dimensions: clarity, simplicity, generality, accessibility, and importance. Key Issues. The implicit assumption that the recovery concept is universally applicable is challenged. This examination raises concerns about the application of the recovery concept cross culturally, across the lifespan, and at different levels of service delivery. Implications. The meaning and application of the recovery concept will need to be cautiously applied to populations traditionally underserved by the mental health care system, including seniors, visible minorities, children and youth, recent immigrants, and refugees. Research exploring the meaning and process of recovery across diverse groups and at different levels of service delivery is needed. Occupational therapists must continue to critically examine the concept of recovery to position our field thoughtfully and inclusively within mental health care reform.

Subjective experiences of illness recovery in individuals treated for first-episode psychosis

PurposeIndividuals with psychotic disorders identify several parallel dimensions of recovery as being important, including illness related, personal and social domains. Learning how patients deal with the experience of psychosis and recovery early in the course of illness may provide insights for improvement of early intervention services. The primary aim of the present research is to explore experiences related to recovery for individuals receiving services following a first episode of psychosis (FEP) in a specialized early intervention (SEI) program and to examine key turning points that shape such recovery.MethodsSemi-structured interviews were carried out with 30 individuals in early recovery following an FEP. Interpretative phenomenological analysis (IPA) was used to examine the subjectively identified important processes and turning points in relation to the illness domain of recovery.ResultsParticipants described several early recovery processes including symptom recovery; reconciling the meaning of the illness experience; regaining control over the experience; and negotiation and acceptance of treatment. Of particular relevance were the various turning points associated with the recovery processes that were described.ConclusionsDifferences in illness acceptance trajectories and the turning points within such trajectories have important implications for understanding psychological adjustment to the experience of psychosis, its diagnosis and treatment. These findings underline the importance of assisting individuals with the construction of meaning following the initial illness experience.

Well-Being and Engagement in Valued Activities: Experiences of Young People with Psychosis

The purpose of this study was to understand how engagement in valued activities contributes to the well-being of young people diagnosed as having psychosis within the past 3 years. Using a qualitative approach, the authors conducted semi-structured interviews and photography-elicited focus groups with 17 participants between the ages of 18 and 24 years who were recruited from an early intervention program for psychoses and a psychiatric service specializing in providing care to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Participants derived six well-being enhancing experiences from engaging in highly valued activities: making meaning; expressing thoughts and emotions; changing physical, emotional, and cognitive states; cultivating skills, strengths, and virtues; connecting and belonging; and making a contribution. These findings highlight the importance of identifying activities that young people perceive as being valuable to their well-being, the meanings and experiences derived from these activities, and how best to support engagement in them.

Thinking out of the box: an intersectoral model for vocational rehabilitation.

This study examined an intersectoral work insertion program that involves the collaboration of six stakeholders from different sectors in the community, including health and vocation. An innovative program logic model has been developed that explains the theoretical rationale behind intersectoral collaboration and work insertion. The principles and ideology of local development have led to the development of this program and have several implications for the social integration of individuals with mental illness. The paper first discusses how such an approach is developed and implemented and follows with a presentation of a model of an intersectoral work insertion program.

Digital Storytelling: An Innovative Tool for Practice, Education, and Research

ABSTRACT Digital storytelling is a method of using storytelling, group work, and modern technology to facilitate the creation of 2–3 minute multi-media video clips to convey personal or community stories. Digital storytelling is being used within the health care field; however, there has been limited documentation of its application within occupational therapy. This paper introduces digital storytelling and proposes how it can be applied in occupational therapy clinical practice, education, and research. The ethical and methodological challenges in relation to using the method are also discussed.

Motivational interviewing: a novel intervention for translating rehabilitation research into practice

Purpose: Despite recent advances in rehabilitation research, moving evidence into clinical practice remains a challenge. This article explores a novel approach to knowledge translation (KT) – motivational interviewing (MI). MI is a style of communication that is typically used to facilitate health related behavior change in patients. Here we explore its potential use as a KT intervention aimed at clinicians. Methods: Commentary. Relevant literature on MI and KT is summarized and discussed by considering how MI could be used in a KT strategy aimed at rehabilitation clinicians. Results: Clinician motivation and readiness to change are key issues influencing implementation of evidence-based practice. We provide an argument suggesting that clinicians’ readiness to change clinical practices can potentially be enhanced through MI. The MI conceptual framework, principles, and strategies, typically used in patients, are discussed here in a novel context – enhancing clinician change in practice. Conclusions: MI is an effective intervention when the goal is to motivate individuals to change a current behavior. We suggest that MI is an evidence-based intervention that has been proven to be effective with patients and warrants study as a promising KT intervention. Implications for Rehabilitation Despite recent advances in rehabilitation research, moving evidence into practice remains a challenge. Clinician motivation is one key issue influencing the implementation of evidence-based practice. Clinician motivation to implement evidence-based practice can potentially be enhanced through an approach called motivational interviewing (MI). Motivational interviewing is an evidence-based intervention that has proven to be effective in promoting behavioral change in patients, and warrants study in terms of its potential as a KT intervention.

Understanding access and use of technology among youth with first-episode psychosis to inform the development of technology-enabled therapeutic interventions

Computers, video games and technological devices are part of young peoples everyday lives. However, their use in first‐episode psychosis (FEP) treatment is rare. The purpose of this study was to better understand the access and use of technology among individuals with FEP, including gaming activities, to inform future development of technology‐enabled therapeutic applications.