"Why I Stay in Community Psychiatric Rehabilitation" -A Semi-Structured Survey in Schizophrenic Patients

Aims: Although community psychiatric rehabilitation plays an important role in returning schizophrenic patients to the society, Many patients in China stay in rehabilitation centers for longer periods of time and subsequently fail to integrate. This study aimed is to explore the underlying causes of this trend and identify possible solutions.Methods: A total of 28 schizophrenic patients were enrolled in this study. We used semi-structured telephone interviews to obtain patients’ perceptions on the effectiveness and attraction of community mental rehabilitation, as well as the difficulties of social inclusion, then applied the grounded theory to analyze the responses. Investigation of interviews include effect of community rehabilitation, attractiveness, and difficulties in social communication.Results: Most patients believe that they have gained knowledge, improved skills, friendship and social circles through community mental rehabilitation, with the sense of belonging and enriched life strongly attracting them to the rehabilitation centers. They felt that the difficulty of further integration into society is mainly because of social prejudice and rejection. In addition, the activities of community mental rehabilitation meet the needs of social communication, which also hinder patients from further entering the society.Conclusions: Schizophrenic patients with long-term stay in community mental rehabilitation centers meet their friendship, sense of belonging and social needs by participating in rehabilitation activities. Providing special social opportunity for these patients can get them out of the rehabilitation center. Overall, it is possible for patients to gradually return to society in a collective form.

The Willingness of Community Psychiatric Management Physicians to Preferentially Recommend Long-Acting Injections in Beijing

Background: Severe mental disorders (SMD) impose a heavy burden on individuals, society, and the country. Under the background of deinstitutionalization, more and more patients return to the community, and the community psychiatric management physicians (CPMP) play an essential role in this process. Long-acting injection (LAI) is an important way to improve compliance and reduce re-hospitalization. Some districts in Beijing have implemented the policy of free LAI. This article aims to find out the willingness of CPMP to preferentially recommend LAI and provide suggestions for follow-up promotion.Methods: All CPMP in 16 districts of Beijing were surveyed. A self-made electronic questionnaire was used to investigate the willingness to recommend LAI in priority. Descriptive statistics, Chi-square test, and logistic regression were used to analyze the data.Results: The willingness of CPMP to preferentially recommend LAI is up to 80%. Participants aged 40–49, female, with higher self-evaluation of psychiatric management knowledge, managing patients who have used LAI in the past, and working in communities with the free LAI policy have higher willingness to recommend LAI in priority.Conclusion: CPMP in Beijing have a positive attitude toward LAI, and most of them have the willingness to recommend LAI to the patients in priority. The recommendation willingness is the basis of prescription decision-making. Therefore, the coverage of free LAI policy should be further expanded in the future to improve the recommendation willingness and thus improve the injection rate of LAI.

The Effectiveness of a Community Psychiatric Rehabilitation Program Led by Laypeople in China: A Randomized Controlled Pilot Study

Background: Community psychiatric rehabilitation has proven effective in supporting individuals and their families in recovering from mental illness. The delivery of evidence-based community rehabilitation services, however, requires health care workers to possess a set of specially trained knowledge and skills. Most developing countries, including China, do not have specially trained mental health personnel. The purpose of this study was to test the feasibility and efficacy of a community psychiatric rehabilitation program delivered by laypeople.Method: We conducted a randomized controlled study. Patients at two sites in Chengdu, China, were randomly assigned to either the laypeople-delivered (LPD) community psychiatric rehabilitation group (N = 49) or the drop-in center control group (N = 45). The outcomes were changes in symptoms, social functioning, and family functioning over 6 months, as measured by the Positive and Negative Syndrome Scale (PANSS), the Personal and Social Performance Scale (PSP), the Family Burden Scale of Disease (FBS), and the Family APGAR index.Results: The number of sessions received over the 12-week period of treatment ranged from 20 to 100%, with a mean completion rate of 77.32% for all 12 sessions. Statistically significant interactions between group and time were found for the total PANSS [F(2, 94) = 12.51, p < 0.001] and both the Negative PANSS [F(2, 94) = 5.89, p < 0.01] and Positive PANSS [F(2, 94) = 6.65, p < 0.01] as well as the PSP [F(2, 94) = 3.34, p < 0.05], FBS [F(2, 94) = 5.10, p < 0.01], and Family APGAR index [F(2, 94) = 4.58, p < 0.01]. The results showed that the experimental group outperformed their counterparts in symptom management, personal social functioning, family care burden, and coherence.Conclusion: These results support the feasibility and efficacy of having laypeople deliver psychiatric rehabilitation services. A discussion and limitations of the study have been included.

Correlates of community rehabilitation service utilization among persons with psychiatric disabilities

Background: The use community psychiatric rehabilitation (CPR) service could facilitate community tenure, autonomy, and recovery among persons with psychiatric disabilities. Nevertheless, based on existing scientific evidence, the conformance rate with the treatment recommendations was modest and the existing services are underutilized in Taiwan. Aims: This study examined the correlates of CPR service utilization based on the Behavioral Model of Health Service Utilization. Especially, the effects of enabling factors were explored. Methods: Five hundred and ninety-two participants from 32 community psychiatric rehabilitation centers in Taiwan completed the questionnaire. There were three groups of independent variables: predisposing, enabling, and need factors. Multiple regression analysis with a hierarchical method of entry was performed. Results: The hypothesized model was significant. Eight independent variables in the model explained 29.3% of the variances in the service utilization. Three enabling factors were significant after controlling for the effects of other factors. The most important correlate was professional relationships followed by family support and welfare subsidy. Conclusions: The findings support that factors associated with CPR service utilization need to be examined separately from general mental health service. CPR program design and service delivery should consider the three most important enabling factors and the extent of service utilization could be enhanced.

Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users' Views

Shared decisionmaking (SDM) is a recommended health communication approach in mental health settings. Yet, implementation of SDM in psychiatric consultations discussing medication management is challenging. Insufficient attention has been given to examine the views of both clinicians and service users together about the experiences of SDM in psychiatric medication management. The purpose of this paper is to examine the views of service users, community psychiatric nurses, and psychiatrists about enablers and barriers of SDM. A thematic analysis of 30 semi structured interviews with service users, psychiatrists, and community psychiatric nurses, in a community mental health team in the UK, was conducted. A service user advisory group was involved in all phases of the research cycle, including data collection, analysis, and dissemination. The results offer a detailed contextualized account of how medication decisions are made. For psychiatrists and service user participants SDM is seen as a way of enhancing service users' engagement in and control over treatment decisions. While psychiatrists value the transactional benefits of SDM, service user participants and psychiatric nurses conceptualize SDM as a long-term endeavor embedded within therapeutic partnerships. For service users these partnerships mitigate acknowledged problems of feeling unable to be fully involved during times of crisis. This study identified a range of barriers and facilitators to SDM concerning psychiatric medications from the lived experience of service users and the professional experience of clinicians. Furthermore, it indicates new potential intervention points to support SDM in psychiatric medication decisions.

Patients’ Experiences of Seclusion during Admission in Psychiatric Settings in KwaZulu-Natal: A Qualitative Study

Background In South Africa, seclusion is one of the practices used in the management of disruptive behaviors in psychiatric settings. Despite its continued use, seclusion is always subject to controversial debates, and patients who undergo it express a range of negative experiences. Objective To explore the experiences of patients regarding seclusion during their admission in a psychiatric hospital. Methods A qualitative descriptive design was used. In-depth interviews were conducted with ten patients attending a community psychiatric clinic in KwaZulu-Natal. Interviews were analyzed using content analysis. Results Two themes emerged from the findings: controversial views of seclusion and negative experiences of seclusion. Seclusion was considered more as a punishment measure which was often used abusively, than a therapeutic intervention. Participants expressed loneliness, humiliation, and powerlessness following their seclusion experience. Limited patient-staff interaction and communication worsened patients’ negativity towards seclusion. Conclusion Findings from this study underscore the need to review practices, policies and procedures regarding the use of seclusion. Seclusion should be only used when the need is absolute and as the last treatment option. Open communication between the care providers and the patients should be emphasized during the time of seclusion. Rwanda J Med Health Sci 2020;3(3):342-361