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AbstractAimsPsychosocial rehabilitation (PSR) is at the core of psychiatric recovery. There is a paucity of evidence regarding how the needs and characteristics of patients guide clinical decisions to refer to PSR interventions. Here, we used explainable machine learning methods to determine how socio-demographic and clinical characteristics contribute to initial referrals to PSR interventions in patients with serious mental illness.MethodsData were extracted from the French network of rehabilitation centres, REHABase, collected between years 2016 and 2022 and analysed between February and September 2022. Participants presented with serious mental illnesses, including schizophrenia spectrum disorders, bipolar disorders, autism spectrum disorders, depressive disorders, anxiety disorders and personality disorders. Information from 37 socio-demographic and clinical variables was extracted at baseline and used as potential predictors. Several machine learning models were tested to predict initial referrals to four PSR interventions: cognitive behavioural therapy (CBT), cognitive remediation (CR), psychoeducation (PE) and vocational training (VT). Explanatory power of predictors was determined using the artificial intelligence-based SHAP (SHapley Additive exPlanations) method from the best performing algorithm.ResultsData from a total of 1146 patients were included (mean age, 33.2 years [range, 16–72 years]; 366 [39.2%] women). A random forest algorithm demonstrated the best predictive performance, with a moderate or average predictive accuracy [micro-averaged area under the receiver operating curve from ‘external’ cross-validation: 0.672]. SHAP dependence plots demonstrated insightful associations between socio-demographic and clinical predictors and referrals to PSR programmes. For instance, patients with psychotic disorders were more likely to be referred to PE and CR, while those with non-psychotic disorders were more likely to be referred to CBT and VT. Likewise, patients with social dysfunctions and lack of educational attainment were more likely to be referred to CR and VT, while those with better functioning and education were more likely to be referred to CBT and PE.ConclusionsA combination of socio-demographic and clinical features was not sufficient to accurately predict initial referrals to four PSR programmes among a French network of rehabilitation centres. Referrals to PSR interventions may also involve service- and clinician-level factors. Considering socio-demographic and clinical predictors revealed disparities in referrals with respect to diagnoses, current clinical and psychological issues, functioning and education.

Objective: Peer-suppport workers (PSW) are people recovering from a psychological disorder who use their knowledge from experience to assist other such patients. by. The development of this practice in France is still recent. A proper evaluation of their integration remains partially lacking, which may be a hindrance to the creation of new PSW positions. This study aimed to explore the level of knowledge of recovery and the role of PSW to better understand the wishes of mental health teams regarding their hiring as well as to identify the barriers that remain to their integration. Method: We conducted an observational study consisting of an online survey based on a standardized questionnaire sent to psychiatrists and psychiatric trainees in the public mental health services of the city of Lyon, France. Seventy two people participated in the study with date being collected from June to September 2020. Results: The majority of the participants were aware that peer support could be a professional practice. It was described that such a role could not be effectively replaced by another mental health professional trained in recovery, and the main benefit expressed for mental health professionals to work with a PSW was the sharing of experience. There was some reluctance, particularly regarding participation in multidisciplinary team meetings or access to a consumer’s medical records. Conclusion: Knowledge of PSW appears to be relatively good among psychiatrists and psychiatric residents. Although there is some reluctance to integrate PSW into a healthcare team, there seems to be a consensus about their value. The insights gained from our study may help to focus awareness strategies about professional PSW.