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Zusammenfassung Ziel Zu untersuchen, welche Milderen Mittel Menschen, die Zwangsmaßnahmen erfahren haben, als besonders nützlich zur Zwangsvermeidung einschätzen und in welchem Ausmaß ihnen diese angeboten wurden. Methode Deutschlandweit wurden 155 von Zwangsmaßnahmen betroffene PatientInnen online oder per Papierfragebogen befragt. Ergebnisse Den Befragten wurden durchschnittlich 4,7 von 25 Milderen Mittel im Vorfeld der zuletzt erlebten Zwangsmaßnahmen angeboten. Die potenziell am nützlichsten eingeschätzten Mittel waren „Krisengespräche“, „Bedürfnisse berücksichtigen“ und „Interesse signalisieren“. Es zeigte sich ein negativer Zusammenhang zwischen Angebotshäufigkeit und potenzieller Nützlichkeitseinschätzung. Ein Großteil der Befragten war unzufrieden mit der erhaltenen Behandlung. Schlussfolgerungen PatientInnen erhalten in eskalierenden Situationen nicht die Mittel, die sie als am nützlichsten einschätzen. Der Fokus sollte vermehrt auf Krisengespräche und einem empathischen, bedürfnisorientierten Umgang gelegt werden.

Mental health stigma (MHS) places a burden on those affected that far exceeds psychosocial harms. Contact-based anti-stigma work has been found effective for several target groups. For medical students however, its efficacy remains unclear. The purpose of this study was to examine the efficacy of contact-based, trialogic anti-stigma training for medical students. A randomized controlled trial (RCT) was conducted, controlling for standard clinical placement in psychiatry. External validity was maximized by including all students (n = 204) who started their 6‑week obligatory psychiatry course during the study period between March and July 2018. Assessments were conducted at the beginning of each of the two covered terms and immediately postintervention. Students who received the anti-stigma training displayed significantly less stigmatizing attitudes after the intervention, measured using the MICA (Mental Illness—Clinicians’ Attitudes) scale as primary outcome. Analogous findings were noted for social distance and stereotypes, whereas these could not be observed for emotional reactions. All significant changes were independent of gender and age. The positive results underpin the research in this field and point towards the inclusion of comparable interventions in regular student curricula. Given the limitation of a missing late follow-up, however, further research regarding the persistence of stigma reduction is needed.

The evidence base for peer support work in mental health is established, yet implementation remains a challenge. The aim of this systematic review was to identify influences which facilitate or are barriers to implementation of mental health peer support work. Data sources comprised online databases (n = 11), journal table of contents (n = 2), conference proceedings (n = 18), peer support websites (n = 2), expert consultation (n = 38) and forward and backward citation tracking. Publications were included if they reported on implementation facilitators or barriers for formal face-to-face peer support work with adults with a mental health problem, and were available in English, French, German, Hebrew, Luganda, Spanish or Swahili. Data were analysed using narrative synthesis. A six-site international survey [Germany (2 sites), India, Israel, Tanzania, Uganda] using a measure based on the strongest influences was conducted. The review protocol was pre-registered (Prospero: CRD42018094838). The search strategy identified 5813 publications, of which 53 were included. Fourteen implementation influences were identified, notably organisational culture (reported by 53% of papers), training (42%) and role definition (40%). Ratings on a measure using these influences demonstrated preliminary evidence for the convergent and discriminant validity of the identified influences. The identified influences provide a guide to implementation of peer support. For services developing a peer support service, organisational culture including role support (training, role clarity, resourcing and access to a peer network) and staff attitudes need to be considered. The identified influences provide a theory base to prepare research sites for implementing peer support worker interventions.

In der Psychiatrie findet seit einiger Zeit ein Wandel hin zu einer verstarkt recovery-orientierten Versorgung statt. Recovery (Genesung) umfasst einen subjekt- oder personenorientierten, ganzheitlichen Ansatz im Umgang mit einer Erkrankung. Die Arbeit von Peerbegleiterinnen und -begleitern als Form der Unterstutzung durch andere Betroffene (Peersupport) leistet in der Psychiatrie diesbezuglich einen wichtigen Beitrag. Mit ihren eigenen Genesungs- oder Krisenerfahrungen konnen sie Patienten und Angehorigen neben ihrem Wissen auch Hoffnung auf Genesung vermitteln. Der vorliegende Beitrag gibt einen Uberblick uber die Einsatzmoglichkeiten der Peerbegleitung, die Evidenz solcher Interventionen sowie den aktuellen Stand der Implementierung in unterschiedlichen psychiatrischen Kontexten. Es werden ausgewahlte, aktuelle Publikationen vorgestellt. Zudem wird aus der Hamburger Praxis der EX-IN-Ausbildung zur Genesungsbegleitung, dem Trialog zwischen Betroffenen, Angehorigen und Professionellen und der Psychoseseminare berichtet sowie Praxisbeispiele und Erfahrungen aus verschiedenen Feldern der Versorgung werden gegeben. Genesungsbegleitung kann in verschiedenen Bereichen der psychiatrischen Versorgung erfolgreich eingesetzt werden, z. B. in der ambulanten Einzelbegleitung, in Gruppenangeboten, Krisenintervention sowie zur Verringerung von Zwangsmasnahmen. Obwohl sich Genesungsbegleitung in vielen verschiedenen Kontexten als erfolgreich gezeigt hat, wird vielfach auch von Schwierigkeiten bei der Implementierung in der psychiatrischen Praxis berichtet. Diese konnen nur mit einer Veranderung im gesamten System und in der Arbeit mit allen Teammitgliedern uberwunden werden.

Im Rahmen von Peer-Begleitung (engl. peer support) erhält eine Person mit einer psychischen Erkrankung Unterstützung von einer Person, die selbst Erfahrung mit Krisen und/oder psychiatrischen Diagnosen gemacht und damit einen guten Umgang gefunden hat. „Peer-Begleiter/innen helfen als Betroffene Betroffenen“, erklärt Stefan Bilmayer, UPSIDES Peer-Begleiter am deutschen Standort Ulm/Günzburg., publishedVersion

Background Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the German language version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a self-report measure of stigmatizing attitudes. Methods Staff (n = 392) on general psychiatric inpatient wards (excluding child, forensic and geriatric psychiatry) at five psychiatric hospitals in Switzerland (n = 3) and Germany (n = 2) participated in the study. The internal consistency of the OMS-HC was examined as well as its factor structure using exploratory and confirmatory factor analyses. To assess the scale’s concurrent validity, we used the Social Distance Scale. Results Internal consistency for the OMS-HC total score was good (α = 0.74), acceptable for the subscales Attitudes (α = 0.62) and Social Distance (α = 0.69), and poor for the Disclosure subscale (α = 0.55). The original three-factor structure fit our data well. The OMS-HC total score and the Social Distance subscale score were significantly correlated with the Social Distance Scale, supporting concurrent validity. Conclusion The German version of the OMS-HC demonstrated satisfactory psychometric properties and can be recommended for future research and intervention evaluation.

Background Peer support is an established intervention involving a person recovering from mental illness supporting others with mental illness. Peer support is an under-used resource in global mental health. Building upon comprehensive formative research, this study will rigorously evaluate the impact of peer support at multiple levels, including service user outcomes (psychosocial and clinical), peer support worker outcomes (work role and empowerment), service outcomes (cost-effectiveness and return on investment), and implementation outcomes (adoption, sustainability and organisational change). Methods UPSIDES-RCT is a pragmatic, parallel-group, multicentre, randomised controlled trial assessing the effectiveness of using peer support in developing empowering mental health services (UPSIDES) at four measurement points over 1 year (baseline, 4-, 8- and 12-month follow-up), with embedded process evaluation and cost-effectiveness analysis. Research will take place in a range of high-, middle- and low-income countries (Germany, UK, Israel, India, Uganda and Tanzania). The primary outcome is social inclusion of service users with severe mental illness (N = 558; N = 93 per site) at 8-month follow-up, measured with the Social Inclusion Scale. Secondary outcomes include empowerment (using the Empowerment Scale), hope (using the HOPE scale), recovery (using Stages of Recovery) and health and social functioning (using the Health of the Nations Outcome Scales). Mixed-methods process evaluation will investigate mediators and moderators of effect and the implementation experiences of four UPSIDES stakeholder groups (service users, peer support workers, mental health workers and policy makers). A cost-effectiveness analysis examining cost-utility and health budget impact will estimate the value for money of UPSIDES peer support. Discussion The UPSIDES-RCT will explore the essential components necessary to create a peer support model in mental health care, while providing the evidence required to sustain and eventually scale-up the intervention in different cultural, organisational and resource settings. By actively involving and empowering service users, UPSIDES will move mental health systems toward a recovery orientation, emphasising user-centredness, community participation and the realisation of mental health as a human right. Trial registration ISRCTN, ISRCTN26008944. Registered on 30 October 2019.

BackgroundPeer support work roles are being implemented internationally, and increasingly in lower-resource settings. However, there is no framework to inform what types of modifications are needed to address local contextual and cultural aspects.AimsTo conduct a systematic review identifying a typology of modifications to peer support work for adults with mental health problems.MethodWe systematically reviewed the peer support literature following PRISMA guidelines for systematic reviews (registered on PROSPERO (International Prospective Register of Systematic Reviews) on 24 July 2018: CRD42018094832). All study designs were eligible and studies were selected according to the stated eligibility criteria and analysed with standardised critical appraisal tools. A narrative synthesis was conducted to identify types of, and rationales for modifications.ResultsA total of 15 300 unique studies were identified, from which 39 studies were included with only one from a low-resource setting. Six types of modifications were identified: role expectations; initial training; type of contact; role extension; workplace support for peer support workers; and recruitment. Five rationales for modifications were identified: to provide best possible peer support; to best meet service user needs; to meet organisational needs, to maximise role clarity; and to address socioeconomic issues.ConclusionsPeer support work is modified in both pre-planned and unplanned ways when implemented. Considering each identified modification as a candidate change will lead to a more systematic consideration of whether and how to modify peer support in different settings. Future evaluative research of modifiable versus non-modifiable components of peer support work is needed to understand the modifications needed for implementation among different mental health systems and cultural settings.

Treatment pressure restricts patients' voluntary and autonomous decisions. Yet interventions involving treatment pressure are widely used in mental health and psychosocial services. This cross-sectional study explored whether mental health professionals' knowledge on five types of treatment pressure (no coercion, persuasion or conviction, leverage, threat, and formal coercion) was associated with sociodemographic, professional and contextual factors. A more positive attitude towards interventions involving treatment pressure was associated with underrating the level of those interventions compared with a predefined default value. The treatment setting and professional group played a minor role in 'leverage' and 'formal coercion' types of treatment pressure, respectively.

Zusammenfassung Ziel Es werden die spezifischen Kompetenzen und Rollen(erwartungen) von und an Genesungsbegleiter (= GB) untersucht. Methode Im Rahmen eines partizipativen Studiendesigns wurde ethnografisches Material in einer Fokusgruppe diskutiert und mithilfe eines multiple-coding-Ansatzes kollaborativ mithilfe der qualitativen Inhaltsanalyse ausgewertet. Ergebnisse GB zeichnen sich durch eine nahbare, offene und wenig klassifizierende Form der Kontaktaufnahme zu Patienten aus. Ihre Rolle in der Versorgung ist oft unklar. Sie ist durch einerseits mehr Flexibilität, andererseits durch mehr Abhängigkeiten geprägt. Schlussfolgerungen Es ist wichtig, die Kompetenzen und Rollen von GB zu definieren und mit den Erwartungen der anderen Berufsgruppen abzugleichen.

Aims Informal coercion is a frequently used form of communication among mental health professionals to influence treatment outcomes. This study investigates the recognition, attitude, and application of different forms of informal coercion by mental health professionals. Methods Mental health professionals of five psychiatric institutions in Germany and Switzerland (n = 424) took part in an online survey assessing the recognition of, attitudes towards, and application of different forms of informal coercion. Results Mental health professionals did not recognize the extent of informal coercion adequately; especially stronger forms were underestimated. Recognition and application of informal coercion was predicted by attitudes towards coercion. Furthermore, there were differences between profession of participants regarding the recognition and application of informal coercion. Conclusions It is important to realize that the extent of applied informal coercion in therapeutic communication is often not recognized by practitioners, although it might interfere with a sound therapeutic relationship.

Schizophrenia is a complex psychiatric disorder with unknown and presumably heterogeneous etiology. While the disorder can have various outcomes, research is predominantly “deficit-oriented” emphasizing the hardship that the disorder inflicts on sufferers as well as their families and society. Beyond symptom reduction, imparting patients with hope and meaning in life is increasingly considered an important treatment target, which may raise self-esteem, and reduce self-stigma and suicidal ideation. The present study compared a psychotherapeutic treatment aimed at improving cognitive insight, individualized metacognitive intervention (MCT+), with an active control in order to elucidate if personal meaning-making and hope can be improved in patients with psychosis across time. A total of 92 patients were randomized to either individualized metacognitive therapy (MCT+) or CogPack (neuropsychological training) and followed up for up to 6 months. The “Subjective Sense in Psychosis Questionnaire” (SUSE) was administered which covers different salutogenetic vs pathogenetic views of the disorder, valence of symptom experiences and the consequences of psychosis. Patients in the MCT+ group showed a significant positive shift in attitudes towards the consequences of their illness over time relative to patients in the active control condition. There was some evidence that MCT+ also enhanced meaning-making. The perceived negative consequences of psychosis were highly correlated with depression and low self-esteem, as well as suicidality. The study shows that a cognitive insight training can improve meaning-making in patients and help them come to terms with their diagnosis.

Background Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. Objective The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. Methods A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. Results The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). Conclusions The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support.

Introduction Police force interaction rates with individuals with mental health conditions are on the rise. International research reveals that the presence of a mental health condition increases the risk for detention and use of force by police officers. Stigmatization of individuals with mental health conditions as dangerous and unpredictable is assumed to have an impact on the likelihood of police use of force. The following study examines a trialogical intervention to reduce stigmatization of individuals with a diagnosis of schizophrenia in a police officer sample. Method 1318 police officers participated in a trialogical contact-based intervention with the aim to reduce stigmatizing attitudes and beliefs. Emotional reactions, stereotypes and social distance were assessed prior to and after the intervention in a one-group design. Results Negative stereotypes were positively associated with social distance in individuals with a diagnosis of schizophrenia and were positively associated with anxiety. Dependent sample t-test revealed reduced anxiety towards individuals with a diagnosis of schizophrenia, less negative stereotypes, and less social distance post intervention. All results were significant, and all effect sizes showed a small to moderate effect. Conclusions Trialogical contact-based, short-term anti-stigma interventions appear to reduce stigmatizing attitudes towards individuals with mental health conditions in a large police force sample. A missing control group is a key study limitation. Further research is needed to examine the effectiveness of the intervention in a randomized-controlled trial. However, the results clearly suggest that anti-stigma interventions could be beneficially introduced into police training.

Zusammenfassung. Angehörige psychisch erkrankter Menschen sind für diese eine wichtige Ressource. Gleichzeitig bringt ihre Rolle zusätzliche Belastungen auf verschiedenen Ebenen mit sich, die auf Kosten der eigenen Gesundheit gehen können. Im Kontext des Hamburger Peer-Projekts im Psychenet-Programm wurden an zehn Standorten in allen Hamburger Kliniken geschulte Angehörige als Angehörigen-Peerbegleiter eingesetzt, um die Situation der Angehörigen psychisch langfristig Erkrankter in Hinblick auf Belastung und Lebensqualität zu verbessern. Im Zeitraum von 11.2011 bis 03.2015 wurden von 242 Angehörigen, die die Peer-Begleitung in Anspruch genommen haben, N = 165 Angehörige untersucht. Mittels Selbstrating wurde zu drei Zeitpunkten (prä, post, Katamnese nach jeweils 6 Monaten) die subjektive Belastung der Angehörigen (FBA), die psychische und körperliche gesundheitsbezogene Lebensqualität (SF-8) sowie die Zufriedenheit mit der Behandlung (ZUF-8) erfragt. Ein Großteil (93 %) der Teilnehmer war zufrieden mit der erhaltenen Peer-Begleitung. Im Vergleich zum Prä-Zeitpunkt war im Anschluss an die Begleitung die Belastung signifikant reduziert und die Lebensqualität verbessert. Nach einem halben Jahr ohne Begleitung blieben Belastung und psychische Lebensqualität konstant – mit steigender Tendenz. Die Ergebnisse geben einen guten Hinweis auf die Wirksamkeit von Angehörigen Peer-Begleitung, welche zukünftig in randomisierten Studien überprüft werden sollte. Peer-Begleitung könnte eine deutliche Lücke in der Unterstützung Angehöriger psychisch Erkrankter schließen und hat damit präventiv für diese Zielgruppe, und indirekt auch für die betroffenen Patienten, einen großen Stellenwert. Die nachhaltige Implementierung wird empfohlen.

BackgroundOne-to-one peer support is a resource-oriented approach for patients with severe mental illness. Existing trials provided inconsistent results and commonly have methodological shortcomings, such as poor training and role definition of peer supporters, small sample sizes, and lack of blinded outcome assessments.MethodsThis is a randomised controlled trial comparing one-to-one peer support with treatment as usual. Eligible were patients with severe mental illnesses: psychosis, major depression, bipolar disorder or borderline personality disorder of more than two years’ duration. A total of 216 patients were recruited through in- and out-patient services from four hospitals in Hamburg, Germany, with 114 allocated to the intervention group and 102 to the control group. The intervention was one-to-one peer support, delivered by trained peers and according to a defined role specification, in addition to treatment as usual over the course of six months, as compared to treatment as usual alone. Primary outcome was self-efficacy measured on the General Self-Efficacy Scale at six-month follow-up. Secondary outcomes included quality of life, social functioning, and hospitalisations.ResultsPatients in the intervention group had significantly higher scores of self-efficacy at the six-month follow-up. There were no statistically significant differences on secondary outcomes in the intention to treat analyses.ConclusionsThe findings suggest that one-to-one peer support delivered by trained peer supporters can improve self-efficacy of patients with severe mental disorders over a one-year period. One-to-one peer support may be regarded as an effective intervention. Future research should explore the impact of improved self-efficacy on clinical and social outcomes.

Background: Peers are people with lived experience of mental illness. Peer support is an established intervention in which peers offer support to others with mental illness. A large proportion of people living with severe mental illness receive no care. The care gap is largest in low- and middle-income countries, with detrimental effects on individuals and societies. The global shortage of human resources for mental health is an important driver of the care gap. Peers are an under-used resource in global mental health. Objectives: To describe rationale and methodology of an international multicentre study which will scale-up peer support for people with severe mental illness in high-, middle-, and low-income countries through mixed-methods implementation research. Methods: UPSIDES is an international community of research and practice for peer support, including peer support workers, mental health researchers, and other relevant stakeholders in eight study sites across six countries in Europe, Africa, and Asia. During the first two years of UPSIDES, a series of qualitative studies and systematic reviews will explore stakeholders’ perceptions and the current state of peer support at each site. Findings will be incorporated into a conceptual framework to guide the development of a culturally appropriate peer support intervention to be piloted across all study sites. All intervention and study materials will be translated according to internationally recognised guidelines. Expected Impact: UPSIDES: will leverage the unique expertise of people with lived experience of mental illness to strengthen mental health systems in high-, middle- and low-income countries. UPSIDES will actively involve and empower service users and embed patient-centeredness, recovery orientation, human rights approaches, and community participation into services. The focus on capacity-building of peers may prove particularly valuable in low-resource settings in which shortages of human capital are most severe.