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The article discusses various reports published within the issue, including one by Nurius et al. on the interrelationships of life course, stress, social disadvantage, and trauma, one by Baron et al. on the challenges of job seeking among people with mental illness and a criminal record and one by Serowick et al. on a money management intervention.

This paper presents findings from in-depth qualitative interviews conducted with 31 formerly homeless tenants and nine direct service staff at a supportive housing site, where a structured process for matching tenants with case managers (“Tenant Choice”) was piloted in which tenants were offered the option of choosing their respective case managers. Tenant Choice aims to increase the opportunity for tenants to make choices that will enable them to have more control over their treatment and recovery and obtain the optimal match between tenant and case manager. This study sought to understand how tenants and staff experienced Tenant Choice, determine whether Tenant Choice was meeting its goals, and identify areas for improvement. The major themes identified were: (1) pre-existing satisfaction drove tenant choices; (2) personal qualities of case managers were valued by tenants over professional qualifications and work experience; (3) the views of tenants and staff differed regarding whether minimal contact versus extended contact leads to better choices and working relationships; (4) the option of choice was valued by tenants regardless of whether it led to a change of case manager; and (5) staff concerns failed to materialize. [ABSTRACT FROM PUBLISHER]

This paper describes the intersection of converging lines of research on the social structural, psychosocial, and physiological factors involved in the production of stress and implications for the field of mental health. Of particular interest are the stress sensitization consequences stemming from exposure to adversity over the life course. Contemporary stress sensitization theory provides important clinical utility in articulating mechanisms through which these multiple levels exert influence on mental health. Stress sensitization models (a) extend understanding of neurobiological and functional contexts within which extreme stressors operate and (b) make clear how these can influence psychologically traumatic outcomes. The value of interventions that are sensitive to current contexts as well as life course profiles of cumulative stress are illustrated through recent treatment innovations. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue of "American Journal of Psychiatric Rehabilitation," which includes a total of eight papers that study on and interpret the findings of qualitative, narrative interviews with persons in recovery from psychotic disorders.

This article presents an interview of Susan Rogers, Director of Special Projects, National Mental Health Consumers' Self-Help Clearinghouse and Mental Health Association of Southeastern Pennsylvania. When Rogers was asked how she became involved in the field of mental health, she said that she had been hospitalized for mental illness, therefore she had a natural interest in the field. When she was asked to describe the better thing in working for the association, she said that she was trying to get important messages out to the public about fighting the stigma and discrimination associated with mental illness.

Collaborative, person-centered approaches to care planning are increasingly recognized as instrumental in supporting attainment of personal recovery outcomes. Yet, though much is known about factors that support person-centered planning, successful implementation often remains an elusive goal. This article reviews international efforts to promote person-centered care planning (PCCP) in the context of a randomized clinical trial in the United States and in the Meaningful and Measurable initiative, a collaborative action research project involving diverse provider organizations in Scotland. The authors review the history of international efforts to implement PCCP and offer preliminary evidence regarding its positive impact on both process outcomes (e.g., the nature of the primary therapeutic relationship and the service-user’s experience) and personal recovery outcomes (e.g., quality of life, community belonging, and valued roles). PCCP will be defined through descriptions of key principles and practices as they relate to both relational aspects (e.g., shifts in stakeholder roles and conversations) and documentation/recording aspects (e.g., how person-centered relationships are captured in written or electronic records). Similarities and differences between the United States and Scottish experiences of PCCP are highlighted and a series of recommendations offered to further implementation of this essential recovery-oriented practice. [ABSTRACT FROM PUBLISHER]

As a foundation of most cultures, with roots in persons’ early development, religion can be a source of hope as well as denigration. Some religious institutions have made attempts to help persons with mental health problems, and some mental health professionals have sought to engage religion resources. These programs have rarely been sustained. In 2008, the Mental Health Center of Denver (MHCD) developed a program to assess the utility of religion resources within mental health care. In response to positive feedback, MHCD appointed a director of Faith and Spiritual Wellness who facilitates community outreach to faith communities and spiritual integration training to MHCD staff. This director initiated a Clergy Outreach & Professional Engagement (COPE) conference for consumers, clergy, and clinicians. The goal was to acknowledge borders between parts of persons’ lives, and to build bridges of collaboration to facilitate care. Participants described lived examples of collaboration to improve mental wellness, including the need for a “solid welcome” from congregations. Subsequent, online surveys generated quantitative data on the usefulness of the conference to encourage and to generate ideas for interaction. Each group affirmed the utility of the conference; consumers and clinicians found the conference more useful than clergy. Qualitative assessment confirmed that across culture differences, participants found common language to demonstrate that persons of different traditions can provide care inclusive of religious resources. This assessment concludes with recommendations for future collaboration, led by consumer input, to expand recovery networks. [ABSTRACT FROM PUBLISHER]

Objective: Youth and young adults with serious mental health conditions have particularly poor records of stable employment, but stable employment is a key to recovery. Employment specialists have a key role in supported employment services in assisting them with employment. This article describes the thoughts and concerns of employment specialists about finding and supporting employment for youth and young adults with serious mental health conditions. Method: The authors undertook 12 intensive interviews with supported employment specialists in two states. These interviews were transcribed and coded by the authors. A number of themes were identified and prototypical examples identified and included in the findings. Results: Although the employment specialists varied in their enthusiasm and optimism about the job, they agreed on key problems that they face in supporting employment for young adults that include employer resistance to hiring people with mental illness, increasing use of online applications, larger organizations not making hiring decisions locally and thus the decisions are not responsive to the employment specialist, resistance from family and mental health professionals and the young adults themselves to full-time employment and putting benefits at risk, and resistance from young adults to disclosing their disability to coworkers and thus being unwilling to take supported employment positions. Conclusions and Implications for Practice: These interviews suggest that some of the features of supported employment practice might need to be modified if young adults with serious mental health issues are to gain employment that over time could lead to significant careers and recovery. [ABSTRACT FROM AUTHOR]

This study aims to understand participant priorities in their personal recovery journey and their perspectives of recovery domains. A card-sort data-gathering technique was employed to elicit priorities in recovery from consumers in supportive housing programs serving adults who were formerly homeless with severe mental illnesses in New York City. Participants (N = 38) were asked to sort 12 cards printed with recovery domains in order of importance and describe the meaning attached to each domain. Mental health (95%), physical health (89%), and housing (92%) were the domains most frequently included and prioritized in the top three rankings. Family (76%) and partner (74%) were also frequently included and endorsed as most important second only to mental health. Housing was prioritized yet rated most important less often (58%). Work, school, hobbies, program, friends, and neighborhood were less frequently endorsed. “Card-sort talk” revealed critical understanding of participants’ priorities and their reasons for endorsing other domains less frequently. Most important to participants was regaining functional independence through improved mental and physical health and access to housing. With underlying principles of efficiency and empowerment, card sort is a promising engagement technique for providers to elicit consumer priorities in their own recovery. [ABSTRACT FROM AUTHOR]

Shared decision making has become a central tenet of recovery-oriented, person-centered mental health care, yet the practice is not always transferred to the routine psychiatric visit. Supporting the practice at the system level, beyond the interactions of consumers and medication prescribers, is needed for successful adoption of shared decision making. CommonGround is a systemic approach, intended to be part of a larger integration of shared decision-making tools and practices at the system level. The authors discuss the organizational components that CommonGround uses to facilitate shared decision making, and we present a fidelity scale to assess how well the system is being implemented. [ABSTRACT FROM AUTHOR]

The experiences of lesbian, gay, and transgender (LGT) individuals with severe mental illness (SMI) have received minimal attention within the clinical and research literatures despite evidence to suggest that these groups receive inadequate psychiatric services. In the present study, 11 individuals from a midsized Canadian city who self-identified as lesbian, gay, or transgender were interviewed about their experiences of sexual identity, gender, mental illness, and psychiatric services. Their narratives were analyzed using grounded theory methods. The findings highlight the complex interactions of the stigma associated with mental illness and LGT identities, as well as the illness and identity-related challenges these persons face in psychiatric services. The participant narratives also speak to resilience and wellness, suggesting that these are cultivated through connection and community. Finally, strategies that service providers can use to deliver more effective services for this population are discussed. [ABSTRACT FROM AUTHOR]

This study examines mechanisms of structural leverage in supported independent living (SIL) for persons with severe mental illness and their relationship with discontinuance of program participation among SIL residents. The investigation employed program-level and consumer-level data available in an urban public mental health system. Findings indicate that housing leverage was a universal feature in SIL programs, with a high level of stringency particularly applied to regulate alcohol and illicit drug use of residents. Housing ownership by residential support teams and stringency of program's response toward behaviors that are generally unregulated in a market rental lease are both associated with an increased risk of leaving SIL. The prevalence of practices used by residential support teams to exert behavioral control and treatment compliance calls into question whether SIL programs were operating according to the principles of tenant rights, consumer choice, consumer control, and empowerment. In order to facilitate the transformation toward recovery-based housing programs, stakeholders in mental health systems need to identify and in turn change features and traditional strategies of the support environment that permit the application of leverage. [ABSTRACT FROM AUTHOR]

In the article the authors reflect on the relationship between mental illness recovery as a process and as an outcome. They believe that recovery as a process should be understood on its own terms and not as a link to recovery as an outcome. Enduring mental illness, effective coping and chronic disabilities are also discussed in the article.

Research on the effectiveness of vocational rehabilitation for individuals with severe mental illness describes many barriers to employment, but it has not addressed 2 important questions: whether perceptions of personal barriers to employment are modified during rehabilitation, and whether reductions in perceived barriers predict better outcome. Self-reported change in barriers pertaining to mental illness (illness-related) and to general factors (common) affecting employment were examined in 56 consumers across the first 3 months of supported employment service. Reductions in illness-related barriers were associated with concurrent improvement in subjective quality of life and hopefulness. Among participants who attained employment, those reporting reductions in illness-related barriers worked nearly twice as long as those with stable barrier ratings. Reductions in common barriers predicted improvement in clinician-rated independent functioning, but they were unassociated with employment outcome. Preliminary findings suggest that perceptions of employment barriers are modified during rehabilitation and that positive modification may promote secondary change in vocational and nonvocational functioning. [ABSTRACT FROM AUTHOR]

It is known that assertive community treatment (ACT) is being used to treat people with borderline personality disorder (BPD), a puzzling trend given the lack of empirical support for this practice and the consensus that reserving ACT for a carefully selected population is critical to the sustainability of this costly intervention. Little is known about the contributors to this phenomenon and the ways in which ACT programs have adapted to the influx of patients with BPD. Many ACT programs in the United States and Canada have integrated dialectical behavioral therapy into the regular ACT programming, a practice that also lacks rigorous evidence of effectiveness. We provide a framework for policy-makers to decide on the optimal role of ACT in the continuum of care for people with BPD, and offer policy recommendations to address this phenomenon. There is an urgent need to generate the missing evidence and to improve and expand the services available to people with BPD, particularly those who are now being treated in ACT programs. [ABSTRACT FROM AUTHOR]

This study reports on an evaluation of Our Town, an innovative case management program based on the Village Integrated Service Agency (ISA) program of Long Beach, Calif., and focusing on providing early, intensive psychiatric and psychosocial intervention for transition-age youth aged 18-25 with serious mental illness. A longitudinal, 2-year pre-post design was used. Two sets of data were collected. The interview data compared participants' progress during the first year of treatment with their functioning during the year prior using in-depth, face-to-face interviews (n = 39 individuals at program entry; n = 22 at 12 months). The tracking data consisted of monthly progress reports from program staff on a reduced set of measures for 18 months. Compared with the year prior to admission, there were no significant changes in quality of life and on most ratings of clinical functioning. However, clients showed improved adult daily living skills; they were more likely to be working (60.8% vs. 21.7%) and less likely to be convicted of a misdemeanor (2.1% vs. 16.0%) or to be homeless (8.7% vs. 30.4%); and they showed a trend to be less likely to be in prison (8.7% vs. 34.8%). During the course of the intervention, members showed progressive improvement in global assessment of functioning (GAF) and ratings of overall progress. In addition, members were less likely to be hospitalized by the end of treatment (0%) compared with the first 6 months of treatment (15.4%), and during the first year of treatment (12.5%), compared with the year prior to treatment (33.3%). The demonstration pilot provided initial support for the effectiveness of an intensive case management model serving a subgroup of transition age youth with very serious mental health problems. [ABSTRACT FROM AUTHOR]

This article concerns the creation of a community agency's integrated mental illness and substance abuse co-occurring disorders assessment and treatment program, with a focus on the barriers and strategies encountered as its development progressed. The discussion of barriers was framed according to the factors (attitude, mastery, leadership, staffing, policies, workflow, and program monitoring) identified by Moser and colleagues (Moser, DeLuca, Bond, & Rollins, 2004) in their comparison of the implementation of Assertive Community Treatment and Integrated Dual Disorders Treatment. It was found that resolution of these barriers was important to the implementation of this program. [ABSTRACT FROM AUTHOR]

This study examined attitudes of mental health professionals toward community integration of the persons with serious and persistent mental illness (SPMI). The sample consisted of staff members from outpatient psychiatric clinics, agencies providing residential services for SPMI, and agencies advocating on behalf of the mentally ill. Each agency type included line workers, supervisors, and directors. A survey instrument for examining attitudes toward community integration of SPMI was developed. The study produced an important association between attitudes and agency types - mental health workers employed at outpatient psychiatric clinics were found to hold significantly more exclusionary attitudes toward SPMI than the workers at other agency types. The article provides evidence of an association between clinical knowledge and attitudes of mental health workers on community integration of SPMI. [ABSTRACT FROM AUTHOR]

This article reports on an original research study about consumer attitudes toward and preferences about their mental health care. It provides empirical findings that demonstrate that deriving information directly from consumers of mental health services offers an important perspective on what services and interventions are necessary to promote psychosocial rehabilitation. Drawing on a research study of self-perception of needs among a sample of 133 consumers diagnosed with serious mental illness and who have been discharged to the community, the findings suggest that consumers view their lives holistically and complexly with an equal concern for their social as well as clinical needs. Engraining consumers as partners in planning treatment is essential if relevant services are to be provided. [ABSTRACT FROM AUTHOR]

Recovery has emerged as a dynamic and effective model for community services for people with serious mental illness. As the efficacy of the model is demonstrated and the reality of recovery is experienced by many consumers, some state hospital systems are expressing an interest in how a recovery model might influence prevailing institutional practices. The challenge in the hospitals may be to recognize at what point in the treatment process the recovery model informs the medical model. Issues to be considered in implementation of the recovery model in state hospitals include the relative dominance of symptom-focused treatment models, hierarchical institutional structures and employee attitudes that tend to resist change, and the effects of chronic institutionalization on patient and staff attitudes toward recovery and autonomy. State hospitals may need to focus on consumer-identified themes such as hope, self-identity, responsibility, and meaning as they attempt to incorporate the recovery model into the hospital culture. These themes are not incongruent with exemplary medical practice. Practical application of the model should consider these dimensions with respect to the key hospital domains of treatment team function, patient role, hospital environment, administrative leadership, and intervention strategies. [ABSTRACT FROM AUTHOR]

This article analyzes the role of social factors in recovery from psychosis, which can be helpful as well as hinder the process of recovery. Informants found their roles as psychiatric patients constituted a major barrier to social adaptation. They experienced stigma both within their natural social networks and mental health services, which often led to self-stigmatization. Given this stigma, the right to have a say in one's care and the right to other forms of self-advocacy were crucial in recovery. The sense of belonging to a place or a group of people outside institutions could be the first step. In addition to existing social networks, informants found these social arenas in their places of employment, clubs, day centres, shelters, or Internet communities. Spending time within new and different people and social groups also raised awareness of informants' desires and abilities to become citizens in their own communities. [ABSTRACT FROM AUTHOR]

Expanding on the introduction to the multinational study described in the first article, this article briefly reviews informants’ contexts of treatment across Italy, Norway, Sweden, and the United States, and provides a cursory description of each informant, organized according to her or his respective country. The informant descriptions are followed by illustrative third-person narratives drawn from interviews with two informants from Sweden. As a counterpoint to themes derived across informant narratives, such as the roles of home, significant others, and coping strategies, this article attempts to illustrate how such themes are interwoven within the context of individuals’ lives and personal journeys toward recovery. [ABSTRACT FROM AUTHOR]

As part of a growing literature describing processes of recovery in psychotic disorders, this report presents findings of an intensive, international study. Open-ended qualitivite interviews were conducted in Italy, Norway, Sweden, and the United States with a total of twelve individuals who have experience of recovery in psychosis. All interviews were translated into English and transcribed. Investigators from each of these countries collaborated in analyzing the interviews and identifying common elements across the twelve narratives. Themes were identified in each of the following areas: 1) how the individual deals with his or her difficulties; 2) the role of material resources; 3) the various roles of formal and informal health systems; 4) the roles, and absence, of significant others; and 5) the roles of social and cultural factors. Salient themes included the person's determination to get better, establishing a degree of self–control, and struggling to achieve a normal life; the need for material resoures and a sense of home, and the importance of going out and engagging in normal activities; the benifits, and costs, of medication, involvement in mutual support/user groups, and participation in various psychosocial interventions; the need to be accepted as, and to accept oneself as, a normal person who exists beyond the psychosis; the impact of stigma and discrimination, and the imortance of having one's rights respected and returning to a meaningful social role through work and/or positive relationships outside of the formal mental health system. Cultural differences between participants from each country were noted primarily in the nature of the opportunities and supports offered rather than in the nature of the processes described. In closing, implications of these findings are considered both for future research on processes of recovery and for making clinical practice more recovery-oriented. [ABSTRACT FROM AUTHOR]

Breakthrough Club of Sedgwick County started New Beginnings School as a flexible alternative to existing community-based educational programs. The school offers remedial coursework, as well as GED and high school diploma curricula, with the goal of facilitating post-secondary education and employment opportunities. Postsecondary educational alternatives include online, video-format, and correspondence courses that complement traditional supported education programming. The various educational program components support mental health consumers pursuing their educational objectives. [ABSTRACT FROM AUTHOR]

This article provides a review of historical development and current trends of psychiatric rehabilitation services in Hong Kong and the United States. A comparison of the Hong Kong and United States psychiatric rehabilitation service configurations and the applicability of the various U.S. approaches in Hong Kong are discussed. Finally, Professor Gary Bond, who visited Hong Kong in July 2000, provides a commentary and reactions to our observations about the development of psychiatric rehabilitation in Hong Kong and discusses issues related to implementing western psychiatric rehabilitation models in Hong Kong and related Chinese communities. [ABSTRACT FROM AUTHOR]

Interviews Anthony Lehman, psychiatrists and principal investigator of the Schizophrenia Patient Outcomes Research Team regarding care of persons with severe and persistent mental illnesses. Ideas about the Schizophrenia Patient Outcomes Research Team study; Opinion towards psychosocial services and psychosocial treatments; His methodology in collecting data for the Patient Outcomes Research studies.