Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness.
Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixed-effects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models.
Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups.
The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.
(The Washington Post) – All her life, Lorri Devlin had been told that the troubling feelings she frequently experienced had a simple cause: she was “just anxious.”
At age 5, Devlin remembers being jolted awake in the middle of the night by the sound of her teeth chattering. Feeling disoriented and that “something was very wrong,” she entered her parents’ bedroom. But when she spoke, the result was gibberish.
Her pediatrician, she recalled, pronounced her “a nervous child . . . an ulcer candidate.” In high school and college, Devlin often felt an odd sense of detachment. As an adult, she developed a ridge of scar tissue from biting the inside of her cheek while she slept. Sometimes if she was severely stressed, she fainted.
Over the years, Devlin, who was trained as a nurse, had tried therapy, anti-anxiety medication and meditation to cope with her condition, which was diagnosed as panic disorder.
“I was ashamed that I was such a weak person,” she said.
But nearly two years ago, an incident on an airplane flight upended the life of the retired insurance company executive. After more than 50 years, Devlin finally learned the cause of the problem that had colored nearly every aspect of her life.Read More
For those struggling with experiences of psychosis, therapy can be beneficial and even life changing. However, there is no single type of therapy, and a great range and diversity of therapeutic approaches have been developed to help different individuals’ needs, which makes deciding which approach is most helpful for an individual not a straightforward choice. Personal Experiences of Psychological Therapy for Psychosis and Related Experiences uniquelypresents personal accounts of those who have received therapy for psychosis alongside professional clinical commentary on these therapies, giving multiple perspectives on what they involve and how they work.
Presented in a clear and accessible way, each chapter includes accounts of a variety of different therapies, including cognitive behavioural therapy, trauma-focused therapy, open dialogue, and systemic family therapy. The reader is encouraged to explore not only the clinical basis for these therapies but also understand what the treatments mean for the person experiencing them, as well as their challenges and limitations. The book also explores the importance of the individual’s relationship with the therapist. As a whole, the perspectives presented here provide unique insight into a range of widely used psychological therapies for psychosis.
With its special combination of personal experiences and concise introductions to different therapies, this book offers a valuable resource for academics and students of psychiatry, clinical psychology, psychotherapy, mental health care and mental health nursing. It will also be essential reading for those considering treatment, their friends and families, as well as mental health professionals, including psychiatrists, clinical psychologists, psychotherapists and nurses.Read More
(HearingTheVoice.org) – In this article, Arya Aryan reviews It’s All in my Head! by Mick, ‘the story of a normal Dutch guy who hears voices inside his head other people can’t hear’.
Emotional, intimate, humorous, compassionate, sincere and democratic, It’s All in my Head is Mick’s account of the stories that the voices he hears have to tell and share with us. This is a book about both the voices’ stories and Mick’s experience and struggle with them, as well as his journey on the road to agency and recovery. It is a journey from being a passive object to which things happen – ‘things are being destroyed’ (115) – to possessing some degree of agency – ‘I made it’ (151). A similar to the Unnamable’s ‘I invented it all’ (117) – though the voices still have their own ontologically autonomous status. It is a very thought-provoking, insightful memoir into the nature of auditory verbal hallucinations, the process of storytelling and its therapeutic function.Read More
Objective: Small business is a favorably regarded institution in America. Given employment disparities among individuals with psychiatric disabilities compared to other workers, self-employment has potential to promote career development and community integration. However, little is known about what has helped or hindered current small business owners with psychiatric disabilities. This exploratory study identified characteristics of individuals’ work and disability histories, as well as business characteristics, that can inform policy and practice development in support of disability-owned small businesses. Method: A nonprobability sample of 60 U.S. adults with a history of psychiatric disability who were self-employed in 2017 completed a web-based survey that asked about demographics, experiences of disability, motivations for self-employment, and business characteristics. Results: Most survey respondents were operating new, very small, unincorporated home-based service businesses on a part-time basis. Respondents were educated, typically with extensive work histories, but had experienced discrimination and unpleasant attitudes from coworkers and supervisors.
Responses highlighted the importance of freedom and work–life balance. Conclusions and Implications for Practice: Self-employment is not necessarily a fit for everyone, but for individuals with psychiatric disabilities, it may be a pathway back to work. The size of the respondent businesses and the part-time nature of the work suggests that individuals with psychiatric disabilities are operating very small businesses that may serve as a wage employment alternative if they are able to grow in the future, or be sustained as a part-time adjunct to public benefits or other paid or unpaid work.
Impact and Implications
Self-employment is one strategy to improve employment and financial outcomes for individuals with psychiatric disabilities while also promoting community inclusion. This research is an important first step in exploring self-employment among people with psychiatric disabilities so that others can learn about how it works. It shows that some self-employed individuals with psychiatric disabilities are running very small businesses part time, supplementing their income. They have had negative experiences in the workplace and have chosen self-employment seeking freedom, flexibility, and work–life balance.
The Foundation for Excellence in Mental Health Care, with the dedicated support of major donors, began funding pilot projects in 2012 for adapting the Finnish Open Dialogue model to the culture and system of care in the United States. Preliminary outcome data sets are too small to draw conclusions about the U.S. programs’ efficacy, but qualitative data on participant and clinician satisfaction with the practice methods argue for further investigation.
To that end, the Foundation is now reviewing RFP submissions for its competitive grant Expanding the Science and Practice of Open Dialogue: An international collaborative multicenter research project to evaluate the effectiveness of Open Dialogue in various mental health care contexts around the world.
Last week in Psychiatric Services, Kim Mueser asked Is More Rigorous Research on “Open Dialogue” a Priority?, to which we reply, unsurprisingly, “Yes.”
Dr. Mueser’s commentary highlights the need to move the science of Open Dialogue practice beyond the small, insular group of developers, advocates, and early adopters and into the mainstream.
Historically, this would have been done with federal dollars, resources which have typically been required to establish an Evidence Based Practice. Unfortunately, federal dollars aren’t available the way they were when the original EBPs were established.
That is why independent, competitive funding from the Foundation for Excellence in Mental Health Care is so important and timely. Seed funding for innovative thinkers is also often the catalyst for those thinkers acquiring other funding to advance science and practice.
Excellence board member and lead of the first U.S. pilot project, psychiatrist Chris Gordon, writes, “My own experience remains that the mode of care in Open Dialogue is vastly more humane, person-centered, and toxicity-minimizing than standard care. We have experienced great satisfaction and enthusiastic endorsement from most (but not all) individuals and families we have served, but we have seen less impact on psychosis, and more need for the use of medications, than were reported by the originators of Open Dialogue in Finland. This may in part be due to the fact that we rarely see people who are completely new to the mental health system; most people we serve come to us already on antipsychotic medications. Still, at times, psychosis can remit and Open Dialogue makes space and time and opportunity for such natural resolution, and helps people avoid getting stuck in an enervating mental health system. So it’s great for much, much better informed consent and collaborative treatment design, and it’s the process I’d want myself for someone I love – if the team includes a competent psychiatrist who appreciates that medicines sometimes can be very helpful.”
(Yahoo! Lifestyle) – When Sheila Wojciechowski was 21 years old and fresh out of college, she found that her new job — working at a school for kids with autism — made her feel increasingly depressed and anxious.
“I would go home and cry, and feel like I was no good at the job,” she says now, at 35, of her quick spiral downward. “I slowly became less and less functional. I couldn’t get out of bed.” After seeing several psychotherapists and “not clicking” with any, she was taken by her parents, with whom she lived at the time, to a psychiatrist.
“I went in, and after, like, 10 minutes, he said, ‘Clearly, you have major depression disorder with anxiety disorder,” Wojciechowski, of Queens, N.Y., tells Yahoo Lifestyle. The doctor, who was citing an official diagnosis, then wrote her a prescription for the antidepressant Lexapro, a selective serotonin reuptake inhibitor (SSRI). Sensing her wariness, he asked her, “If you had a headache, wouldn’t you take an Advil?”
To that, Wojciechowski recalls, “I said yes. It made sense, and I tried it — reluctantly. … I knew it was not right from that first pill, but you do what you can with the information you have at the time.”Read More
Kudos to the Canadian Clinicians for Therapeutic Nutrition. They described their use of whole-food nutritional strategies to help combat the burden of chronic non-communicable disease in their patients, which they suggested was more important than focusing on meat versus plant-based foods. Their essay was an excellent reminder of why excluding processed foods is the first step toward improved physical health. However, it is also important to draw attention to the value of a whole-foods diet for brain health. Given that at least 20 per cent of our population is now diagnosed with a mental disorder, compared to less than one per cent in 1960, we must not neglect the importance of nutrition “above the neck.”Read More
(MedicalBag.com) – Despite the important role diet plays in patient health, many physicians lack training in the area of nutrition. Culinary medicine, an emerging field in medical education, is looking to change that.
Culinary medicine is “a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine.”1,2Put simply, culinary medicine aims to teach people how to cook while also teaching them about nutrition. As participants learn how to prepare food, they also learn how different foods affect the body.
For physicians, culinary medicine can help fill gaps in knowledge about nutrition. Many physicians never receive robust training in nutrition, which can make it difficult or impossible to answer patients’ diet-related questions. Because many conditions have a significant dietary component, physicians with more nutrition knowledge can help better treat patients with conditions such as diabetes, obesity, and heart disease.
For patients, culinary medicine allows them to take control of their health through food. Food is person-specific: a diet that works for one person will not be the best diet for everyone. Through culinary medicine, both healthy patients and patients with chronic conditions can cook high-quality meals that can improve their well-being.Read More
(The British Psychological Society) – We are living in a microbial world. The microbes were there first, and in terms of genes we are more than 99 per cent microbial. As a neuroscientist it’s humbling to think that the weight of our gut microbes is about the same as our brain. In terms of cells we’re 1.3:1 microbial (next time you go to the bathroom and get rid of some of your microbes, just think: you’re becoming more human).
Remember the story of Pinocchio? The puppet has many adventures, but his creator Geppetto is rarely far away, guiding him along. This parallels the relationships that our brain has with our gut microbes: Who is really in charge?
We personify our emotions in our gut. We have gut feelings, gut instincts, we make gutsy moves, we are gutted, we have butterflies in our tummies. Over the last 13 years, my lab in Cork, in close collaboration with my clinical colleague Ted Dinan, has been trying to understand the overarching biology that may link these everyday phrases.