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A considerable proportion of patients with schizophrenia perform below population norms on standardized neuropsychological tests, and the performance of those performing within normal range is lower than predicted based on parental education. Cognitive impairment predates the onset of psychosis, is observed during symptom remission and in non-affected first-degree relatives of patients. At the present time, cognitive deficits are regarded as key features of schizophrenia, important determinants of poor psychosocial outcome and targets for both pharmacological and non-pharmacological treatment strategies. A group of eight key opinion leaders reviewed and discussed latest advances in scientific research and current good clinical practices on assessment, management, and treatment of CIAS. In the present paper they summarize the current evidence, identify main gaps between current knowledge and mental health services clinical practice, and provide practical recommendations to reduce the gap. [ABSTRACT FROM AUTHOR]

Purpose: People with schizophrenia in Sub-Saharan Africa often live in very difficult conditions, suffer important social isolation and usually do not receive any kind of treatment. In this context, some non-governmental initiatives have come to light, providing accommodation, food, primary healthcare, medications and, in some cases, education and rehabilitation. The aims of this study were to assess feasibility, effects, and acceptability of a Cognitive Remediation Therapy (CRT) intervention in the particular context of psychiatric rehabilitation in Togo and Benin. Methods: Patients diagnosed with schizophrenia accessing the "Saint Camille" association rehabilitation centers in Togo and Benin during the enrollment period were allocated consecutively with a 1:1 proportion to receive a manualized CRT intervention (46 one-hour sessions over 14 weeks) or continuing Treatment As Usual (TAU). The assessment included validated measures of cognitive performance and real-world functioning and was performed at baseline and at the conclusion of treatment. Results: All subjects that were invited into the study agreed to participate and completed the intervention, for a total of 36 participants. CRT produced greater improvements than TAU in processing speed, working memory, verbal memory, cognitive flexibility, and executive functions measures, with moderate to large effect sizes, in particular in processing speed and working memory domains. Conclusions: CRT represents a feasible and effective psychosocial intervention that can be implemented even in contexts with very limited resources, and could represent an important instrument to promote the rehabilitation process of people living with schizophrenia in low-income countries. [ABSTRACT FROM AUTHOR]

Objective Individuals with chronic mental disorders face various challenges, which are not merely confined to the individual but also involve family caregivers and specialists in the field. Psychological and social rehabilitation assists in improving the functioning of individuals with mental disorders and facilitates their return to mainstream life. This study aims to investigate the challenges encountered in the rehabilitation process of these individuals. Materials & Methods This study employed a qualitative directional content analysis method. The sample consisted of 13 individuals with chronic mental illnesses, 3 family members, and 6 specialists with experience in patient care. Following ethical approval and obtaining informed consent, in-depth, unstructured interviews were conducted, aligning with the research objectives. Purposeful sampling and maximum diversity strategies were utilized to select and invite participants subjected to in-depth, semi- structured interviews. Data analysis followed Granheim and Lundman's approach. Results The analysis of the interviews revealed that the essence of this study is "striving to respond to weakened identity." The categories and subcategories extracted in this study include social limitations (social exclusion, societal negligence), instability (turbulent lifestyle, family as an overlooked entity, and economic pressures), therapeutic challenges (treatment inconsistency, therapist-related challenges, the complex nature of the illness, and postdischarge concerns), structural and macro challenges (social media neglect, incomplete perspectives, financial and credibility challenges) and loss of agency and volition (identity weakening, lack of balance between independence and support). Conclusion The rehabilitation of individuals with chronic mental disorders faces various challenges at individual, interpersonal, familial, organizational and structural levels. Strengthening the psychological and social aspects of rehabilitation can provide a better and more sustainable basis for treatment for these patients. Enhancing the roles and interventions of psychological and social rehabilitation teams, coordinating therapeutic interventions, supporting the families of patients, socializing behaviors toward these patients and their families, and paying more attention to the psychological and social rehabilitation of patients can result in better short-term and long-term outcomes for various stakeholders involved in the rehabilitation process. [ABSTRACT FROM AUTHOR]

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed. [ABSTRACT FROM AUTHOR]

Objective: The theory of social practice describes a therapeutic community process for people living with serious mental illness, while the methods involve engaging people to become collaborators and contributors to a social environment. Confusion in the mental health field surrounding the applied methods of social practice—as occurring within the clubhouse model—has not been sufficiently addressed. This article aims to outline the methodology of social practice, as well as provide guidance on its practical application. Methods: Specific constructs of social practice are defined, and empirical support is provided to emphasize how practices to support recovery are applied in the clubhouse. Results: Five key elements of social practice—that is, transformational social design, engagement, relationship development, natural feedback and intervention, and transitional environments— are described. Practical examples of therapeutic techniques associated with each element are also provided. Conclusions and Implications for Practice: Social practice addresses the social determinants of health by focusing on five key elements that support individual and community recovery. Here, we detail social practice techniques utilized in the clubhouse as a way of unifying theory, providing practical guidance to mental health professionals and improving the measurement of community as therapy for serious mental illness. Impact and Implications: This article outlines therapeutic methods applied in the clubhouse model according to the theory of social practice. We provide concrete examples of relevant techniques to guide professionals in applying the model. [ABSTRACT FROM AUTHOR]

Objective: Though the efficacy of the Clubhouse model's interventions and practices in supporting recovery from serious mental illness (SMI) have been demonstrated by prior research, the causal mechanisms and theory driving these outcomes have yet to be comprehensively defined. This theory article aims to synthesize existing knowledge of these methods to define a unified theory of social practice, outline its role in SMI recovery, and discuss future implications. Method: Historical, theoretical, and practical foundations of social practice were synthesized to define a current theory of social practice and expand the term to apply to the methods and interventions that define the Clubhouse model. Results: Based on prior theory and findings, we define social practice as "the informed application of a specialized form of environmental therapy that utilizes an intentional community to assist people in their recovery." Key facets of social practice in the Clubhouse model of SMI recovery are discussed, including the efficacy of the practice in addressing SMI outcomes such as isolation and low self-efficacy, as well as its impact on both internal and external motivational forces. Conclusions and Implications for Practice: The theory of social practice describes a process of engaging people to become collaborators and contributors to a social environment. This article describes the philosophy and practices of Clubhouses and introduces the theory of social practice as an empirical means of unifying and communicating the methods, practices, and outcomes of both the Clubhouse model and the broader implications of intentional community as therapy. Impact and Implications: This article unifies decades of findings from the Clubhouse model to define the theory of social practice—that is, the use of intentional community in recovery from serious mental illness. We discuss the historical and theoretical foundations of the model, outline the role of the theory in mental health recovery models, and discuss potential future implications and applications of social practice. [ABSTRACT FROM AUTHOR]

Objective: There is growing utilization and acknowledgement of the benefits of community-based participatory action research (CBPAR) in advancing health practices and equity. However, the sustainability and full impact of CBPAR in health care settings faces many obstacles and limitations. The present article examines the synergies between CBPAR and Clubhouse programs, presents the demonstration and ongoing implementation of sustainable CBPAR practices at Fountain House in New York City, and offers lessons learned for other Clubhouses and similar programs seeking to integrate CBPAR. Methods: Alignment in practice and principles between CBPAR and Clubhouse programs are presented. The innovation and ongoing sustainable CBPAR practices in the Fountain House Clubhouse program are examined with a contribution of practice guidance for other Clubhouse and similar programs in further adopting and learning CBPAR into participatory health practices. Results: Clubhouse psychosocial rehabilitation programs present structurally conducive settings for the success and sustainability of CBPAR activities and projects. The Fountain House examination and demonstration of integrating CBPAR sustainably into core Clubhouse programming presents opportunities for further integration, research, and practice guidance in uniquely leveraging features of the Clubhouse model to advance health equity and rehabilitative outcomes through CBPAR. Conclusions and Implications for Practice: The opportunity for incorporating structural CBPAR activities within Clubhouse programs can be informed by the experience, processes, and lessons applied in the Fountain House example. Further research into the rehabilitation, program, and equity benefits of Clubhouse and CBPAR integration could uniquely contribute to the advancement of sustainable participatory research practices across the mental health field generally. Impact and Implications: The article provides an examination of the synergies between community-based participatory action research and Clubhouse programming through an examination of the sustainable integration of community-based participatory action research activities within a particular Clubhouse program that can serve as a guide and resource for replication. [ABSTRACT FROM AUTHOR]

Objective: Individuals with psychiatric disorders are incarcerated at disproportionately high rates and often have low educational attainment. Access to psychiatric and education services within prisons has been described as inadequate, but recent data are lacking. The authors sought to assess the association of psychiatric disorders with both educational attainment before incarceration and access to psychiatric and education services during incarceration. Methods: Data were from the 2016 Survey of Prison Inmates, a national survey of adults incarcerated in U.S. state and federal prisons (N=24,848). Multinomial regression was used to identify associations of educational attainment before incarceration with psychiatric disorders and sociodemographic factors. Multivariable logistic regression models were used to assess associations of psychiatric disorders with access to psychiatric and education services during incarceration and with sociodemographic factors. Results: Before incarceration, 57.3% of survey respondents had less than a high school diploma. Across four education and psychiatric services, only 8.4%–44.8% of respondents reported participating in these services during incarceration, despite 57.3% reporting a psychiatric or learning disorder. Psychiatric disorders were associated with lower educational attainment before incarceration and lower access to education services during incarceration. Psychiatric disorders were associated with higher odds of access to psychiatric services during incarceration. Men had lower educational attainment before incarceration and lower odds of accessing psychiatric and education services during incarceration. Conclusions: Incarcerated people had a high need for psychiatric and education services. Individuals with psychiatric disorders had lower odds of participating in education services during incarceration, highlighting the need for policies and services that increase participation. [ABSTRACT FROM AUTHOR]

Objective Individuals with chronic mental disorders face various challenges, which are not merely confined to the individual but also involve family caregivers and specialists in the field. Psychological and social rehabilitation assists in improving the functioning of individuals with mental disorders and facilitates their return to mainstream life. This study aims to investigate the challenges encountered in the rehabilitation process of these individuals. Materials & Methods This study employed a qualitative directional content analysis method. The sample consisted of 13 individuals with chronic mental illnesses, 3 family members, and 6 specialists with experience in patient care. Following ethical approval and obtaining informed consent, in-depth, unstructured interviews were conducted, aligning with the research objectives. Purposeful sampling and maximum diversity strategies were utilized to select and invite participants subjected to in-depth, semi-structured interviews. Data analysis followed Granheim and Lundman’s approach. Results The analysis of the interviews revealed that the essence of this study is “striving to respond to weakened identity.” The categories and subcategories extracted in this study include social limitations (social exclusion, societal negligence), instability (turbulent lifestyle, family as an overlooked entity, and economic pressures), therapeutic challenges (treatment inconsistency, therapist-related challenges, the complex nature of the illness, and postdischarge concerns), structural and macro challenges (social media neglect, incomplete perspectives, financial and credibility challenges) and loss of agency and volition (identity weakening, lack of balance between independence and support). Conclusion The rehabilitation of individuals with chronic mental disorders faces various challenges at individual, interpersonal, familial, organizational and structural levels. Strengthening the psychological and social aspects of rehabilitation can provide a better and more sustainable basis for treatment for these patients. Enhancing the roles and interventions of psychological and social rehabilitation teams, coordinating therapeutic interventions, supporting the families of patients, socializing behaviors toward these patients and their families, and paying more attention to the psychological and social rehabilitation of patients can result in better short-term and long-term outcomes for various stakeholders involved in the rehabilitation process.

Introduction: The article reports the healing elements of an eclectic life skills programme (ELSP) from the perspective of group members. An ELSP utilising open groups was developed to manage clients with mixed diagnostic profiles and different stages of recovery simultaneously. The aim was to explore the healing elements of an ELSP. Methods: Maximum variation purposive sampling was used to select six participants for the phenomenological inquiry. Data collection is comprised of observations, semistructured interviews, and reflective journals. Data analysis comprised an inductive thematic analysis. Consumer Involvement: Participants all attended groups offered within the ELSP. They participated in two semistructured interviews: the first interview in the week following admission and the second just before discharge. In addition, they documented their experiences in reflective journals for the duration of their participation. Findings: The analogy of a kaleidoscope portrayed the four themes; three pertained to structural dynamics, namely, programme mirror, facilitator mirror, and mirror of other group members. The fourth theme, namely, the magical pattern, pertained to personal sense‐making by individual group members. Conclusions: The dynamic interplay of healing factors, captured in the themes, facilitated healing. Self‐reflection was integral to the creation of a bespoke, facilitated self‐learning process with direct application in group members' own lives. [ABSTRACT FROM AUTHOR]

A considerable proportion of patients with schizophrenia perform below population norms on standardized neuropsychological tests, and the performance of those performing within normal range is lower than predicted based on parental education. Cognitive impairment predates the onset of psychosis, is observed during symptom remission and in non-affected first-degree relatives of patients. At the present time, cognitive deficits are regarded as key features of schizophrenia, important determinants of poor psychosocial outcome and targets for both pharmacological and non-pharmacological treatment strategies. A group of eight key opinion leaders reviewed and discussed latest advances in scientific research and current good clinical practices on assessment, management, and treatment of CIAS. In the present paper they summarize the current evidence, identify main gaps between current knowledge and mental health services clinical practice, and provide practical recommendations to reduce the gap.

The Individual Placement and Support (IPS) method is an intervention model to support the job placement of people with mental disorders in active job search policies. This pathway is aimed at obtaining a competitive job in the open market. The Agreement Protocol signed between the Mental Health Centre and the «LaboratorioAperto» Non-profit organization has enabled this practice to be implemented since 2013, through Recovery-oriented paths: a productive and satisfying life condition despite the limitations of the illness. This work aims at: describing the phases through which the IPS Method is implemented, outlining the projects activated so far, highlighting the critical elements identified and addressed, presenting the most effective standardised assessment tools. The work placement of people with psychiatric vulnerability fosters social cohesion and desensitisation to prejudices, through work man satisfies not only his material needs, but also other more intimate and profound needs, which involve him both as an individual and as a social being, allowing greater psychophysical well-being. Current Evidence-Based tools allow only partial evidence of the improvements obtained through work activity, and this lack has prompted the team of professionals to create a specific form: the Individual Evaluation Grid. [ABSTRACT FROM AUTHOR]

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Introduction Palliative care is a medical field focused on enhancing the quality of life for terminally ill patients rather than curing their disease. It involves a multidisciplinary team that aims to improve patients' well-being, manage pain, alleviate other physical symptoms, and ease mental suffering. The purpose of this work is to show how much rehabilitation is important for palliative patients and improves the quality of life. State of Knowledge The article contains different types of rehabilitation that seem to be useful in daily challenges of palliative patients. Chosen types of rehabilitation are: physical, pulmonary, speech and language and psychosocial. Material and methods The method obtaining the data is based on medical reviews including WHO reports about rehabilitation and palliative care showing what is a relationship between them. Summary All of the studies and reviews showed a strong relationship between each type of rehabilitation and improvement of quality of life of palliative patients. Each type of rehabilitation touches different areas of struggle for palliative patients as mobility, pain, communication with surrounding, anxiety, stress and social exclusion.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Since the 1940s, the Clubhouse model of psychosocial rehabilitation has evolved towards a comprehensive practice of social theory and intervention. Despite the model's cost effectiveness and observational evidence of its efficacy, empirical research remains lacking. The current narrative review examines studies from recent years (2015–2021), not to assess study rigor, but to identify trends in research aims, findings, and methodology, as well as specify future research directions. A narrative review was conducted using PRISMA guidelines. Using the search term "Clubhouse," 194 articles were identified in online databases. 38 met criteria for inclusion. Most studies were qualitative (60.5%) and few utilized experimental or quasi-experimental designs (7.9%). Narrative synthesis revealed research aims and outcome variables falling into six key areas: social integration and connectedness, quality of life (QOL), recovery outcomes, relational dynamics, policy, and virtual adaptations of the model. Findings indicate that recent Clubhouse-related research trends have primarily involved studies of social connectedness, QOL, recovery, relationships, and policy, as well as studies examining the value of the virtual Clubhouse in maintaining well-being. However, heterogeneity of methodologies and measures present a critical limitation to assessing results across studies. Options for increasing experimental methodologies in this area are reviewed. Recommended future directions involve moving towards a biopsychosocial approach to clarifying the mechanisms through which the model promotes recovery—aims that may yield implications beyond the realm of serious mental illness. [ABSTRACT FROM AUTHOR]

Peer support providers are part of the behavioral health workforce. Research indicates that peer support helps care recipients achieve recovery and engage with behavioral health services. This article investigated how many U.S. behavioral health facilities offer peer support services and compared the frequencies of peer support services in facilities providing mental health and substance use services. The authors conducted a secondary analysis of facilities in the Substance Abuse and Mental Health Services Administration's National Mental Health Services Survey (N=11,582) and the National Survey of Substance Abuse Treatment Services (N=13,585), including descriptive and comparative analyses on reported mental health and substance use treatment services in the 50 U.S. states in 2017. The findings revealed state-to-state variation in the number and availability of mental health and substance use service facilities and in facilities that reported providing peer support services. Facilities providing substance use treatment services offered peer support services at more than twice the rate (56.6%) found in mental health facilities (24.7%). The authors also identified program characteristics associated with the inclusion of peer support services in behavioral health. Provision of peer support services was more frequently reported by public facilities than by for-profit and nonprofit facilities. Behavioral health facilities that serve individuals with serious mental illness and co-occurring substance use and mental health conditions reported offering peer support at a higher rate than did other facilities. Inconsistent definitions of peer support in the two surveys limited the comparability of the findings between the two reports. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the increasing use of comprehensive rehabilitation models for people with severe mental illness (SMI), there are still limitations to their implementation and replicability in a consensual way, particularly in Latin American countries. The REINTEGRA program aims to be a standardized model of comprehensive rehabilitation focused on psychosocial and cognitive improvement through a set of interventions on different areas of people’s functionality, with the goal of reintegrating people with SMI into the labour market. In this paper we summarize the protocol for its subsequent implementation in a mental health institution in Mexico. Method The protocol is based on a quasi-experimental, prospective longitudinal study, with a pragmatic or naturalistic control group. It will be carried out in three phases. Phase 1 consists of a series of interventions focused on psychosocial improvement; Phase 2 focuses on cognitive and behavioral improvement treatments; and Phase 3 targets psychosocial recovery through rehabilitation and reintegration into the labour market. The overall procedure will be monitored with standarized evaluations at different stages of the program. Discussion This study presents a model of integral rehabilitation of people with SMI. At the moment, one of the obstacles to overcome is the organization and procedural control of the different actors needed for its implementation (nurses, psychologists, doctors, companies, institutions, etc.). REINTEGRA will be the first comprehensive rehabilitation model that includes systematized procedures for job reinsertion for people with SMI in Mexico, which aims to be a standardized tool of easy adaptation and the replicability for other mental health centers and institutions.

Abstract Aims Psychosocial 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. Methods Data 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. Results Data 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. Conclusions A 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.

IntroductionPharmacological treatment may be effective for treating positive symptoms of schizophrenia; no evidence of clinically significant effects on negative and cognitive symptoms, social and behavioral functioning. This review investigated treatment outcomes of multiple (at least four sessions in 4 weeks) group music therapy sessions adjunct to standard care in inpatients with chronic schizophrenia.MethodsA systematic review search of five electronic medical and psychological databases conducted using keywords “music therapy” and “schizophrenia” up to December 2021. Screening was performed for published articles on any adjunct multiple group music therapy (four sessions in 4 weeks minimum) adjunct to “treatment as usual” for inpatients with “chronic” schizophrenia. All study outcomes were all included. Risk of bias of all studies was assessed.Results1160 articles were screened, and 13 randomized controlled trials (RCTs) with a total of 1,114 inpatients were included. Ten RCTs reported open group sessions with active structured music making (ASMM) combining passive music listening (PML) and/or active singing, playing instruments, and improvisations while three other studies applied PML only. Four studies reported significant outcomes for both positive and negative symptoms. Ten of the thirteen studies recorded significant improvements in negative symptoms, behavioral and social functioning. Lasting significant effects were found in a longitudinal RCT with 272 samples evaluated unguided pre-recorded PML as a coping method lasting up to six months and similar results found in another two longitudinal RCTs. Secondary outcomes measured cognition, mood, social interest and function, self-care ability, interpersonal relationships, and QoL all showed significant outcomes. The significance level for pre-post intervention and between-group measures ranged from p

Introduction: In Portugal, a reform to implement Long-term mental health care (LTMHC) started in 2017 allowing patients with severe mental illness receiving psychosocial rehabilitation to regain their autonomy and be reintegrated into their communities. Aim: To describe the first steps of the Portuguese LTMHC implementation and to assess the relationship between the LTMHC's demand (referrals) and supply (vacancies and occupancy). Methods: We conducted a national retrospective observational study to analyse the LTMHC referrals, vacancies and occupancy between mid-2017 (LTMHC establishment) and December 2022. We described and analysed the associated indicators through time and geography, as well as performed a simultaneous regression model to evaluate the relationship between supply and demand. Results: There were 1,192 referrals to the LTMHC, of which 99 (8.3%) were made for childhood and adolescence structures. The maximum support residence (RAMa, 'Residência de apoio máximo'), designed for patients with higher disabilities, had the highest number of referrals. Additionally, since the opening of vacancies in different institutions, residential structures became quickly saturated. On the other hand, domiciliary services were those with the lowest occupancy. Our estimates support that the vacancies (supply) are induced by the referrals (demand), and referrals are also related to the location of LTMHC facilities. Conclusion: LTMHC is still in the initial stage of development in Portugal, and it is expected to receive financial support through the Recovery and Resilience Programme. According to the occupancy rates and referrals made, residential structures seem to be a priority, being also important to explore the partial use of domiciliary services. The geographical distribution of vacancies can also be a concern, considering the important proximity to the community in LTMHC. [ABSTRACT FROM AUTHOR]

Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically uninsured, low-income individuals with serious mental illness. Adults in the public mental health system (N=42) were randomly assigned (1:1) to receive SDC or services as usual and were assessed at baseline and 6- and 12-month follow-ups. Outcomes included perceived competence for mental health self-management, met and unmet needs, degree of autonomy support, self-perceived recovery, and employment. Mixed-effects random regression analysis tested for differences in longitudinal changes in outcomes between the two study conditions. Differences in service costs were analyzed with negative binomial regression models. Compared with individuals in the control condition, SDC participants reported greater improvement in perceived competence, met and unmet needs, autonomy support, recovery from symptom domination, and employment. No differences were found between the two groups in total per-person service costs or costs for individual services. The most frequent nontraditional purchases were for medical, dental, and vision services (33%) and health and wellness supports (33%). Satisfaction with SDC services was high. Mental health SDC services achieved participant outcomes superior to treatment as usual, with equivalent service use and costs and high user satisfaction. This model may be well suited to the needs of uninsured adults with low income who receive public behavioral health care. [ABSTRACT FROM AUTHOR]

Abstract Background Current outcomes for mental illness are widely regarded as poor. Since the introduction of psychotropic medications in the mid 1950’s, previous psychosocial practices were minimized in favor of medication focused treatment. The majority of large U.S. state hospitals have closed with records destroyed or in storage, inaccessible to researchers. This creates barriers to studying and comparing outcomes before and after this shift in treatment practices. Aims The study aim was to examine discharge outcomes in relation to length of stay and diagnosis in one U.S. state hospital. Methods This case series study examined 5618 medical records of participants admitted to one state hospital from 1945 to 1954, the decade prior to adoption of psychotropic medications. Results Of the 3332 individuals who left the facility, over half (59.87%) of first episode hospitalizations were discharged within 1 year, and 16.95% were hospitalized for more than 5 years. 46.17% of all admissions were discharged from hospital with no readmission. The most common diagnoses included schizophrenia, other forms of psychosis, and alcoholism. In the decade before the introduction of psychotropic medications, participants were often admitted for a single episode and returned to their homes within several years. Conclusions Although limited to one site, findings suggest that discharge outcomes prior to psychotropic medication as a primary treatment for mental illness may be more positive than previously understood.

Abstract This qualitative study reevaluated findings of an earlier study, revealing Communal Pet Dog Ownership enhances client recovery and the environment at an adult psychiatric residential rehabilitation facility. Seven staff and seven clients completed surveys, interviews and focus group. Findings were similar to previous study. Seven beneficial themes emerged: improves mental health, improves emotional state, motivation to exercise, connectedness, positive environment, opportunities for a caring role and therapy. Two non-beneficial themes emerged: emotional impacts, burden of caring. Limitations include sample bias. More considerate utilization of a pet dog within the facility is suggested. Utilizing dogs for staff wellbeing merits further research. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing use of comprehensive rehabilitation models for people with severe mental illness (SMI), there are still limitations to their implementation and replicability in a consensual way, particularly in Latin American countries. The REINTEGRA program aims to be a standardized model of comprehensive rehabilitation focused on psychosocial and cognitive improvement through a set of interventions on different areas of people's functionality, with the goal of reintegrating people with SMI into the labour market. In this paper we summarize the protocol for its subsequent implementation in a mental health institution in Mexico. Method: The protocol is based on a quasi-experimental, prospective longitudinal study, with a pragmatic or naturalistic control group. It will be carried out in three phases. Phase 1 consists of a series of interventions focused on psychosocial improvement; Phase 2 focuses on cognitive and behavioral improvement treatments; and Phase 3 targets psychosocial recovery through rehabilitation and reintegration into the labour market. The overall procedure will be monitored with standarized evaluations at different stages of the program. Discussion: This study presents a model of integral rehabilitation of people with SMI. At the moment, one of the obstacles to overcome is the organization and procedural control of the different actors needed for its implementation (nurses, psychologists, doctors, companies, institutions, etc.). REINTEGRA will be the first comprehensive rehabilitation model that includes systematized procedures for job reinsertion for people with SMI in Mexico, which aims to be a standardized tool of easy adaptation and the replicability for other mental health centers and institutions. [ABSTRACT FROM AUTHOR]

Abstract The Social Skills Training (SST) presents satisfactory results in different clinical and non-clinical populations. The objective of this study is to evaluate the effects of SST on the perception of quality of life of drug users under treatment in post-intervention and follow-up conditions. It is a quasi-experimental study. The instruments used in the study were: CHASO, EMES-M, Extensive Interaction Semi-structured Test and WHOQOL. The study sample was composed of forty male drug users who participated in SST in a Therapeutic Community. The results indicate a statistically significant increase in the ability of defending rights, dealing with and keeping calm upon criticism, with medium effect size on the ability to refuse requests, refuse drugs and quality of life (psychological domain). SST was found to contribute to the development of specific social skills and as a complementary strategy in the Therapeutic Community.

Objective: Community-based residential rehabilitation for people experiencing severe and persistent mental illness (SPMI) is increasingly available as an alternative to psychiatric inpatient care. Understanding who accesses these services and their outcomes will inform the optimal allocation of limited public mental health resources. Method: This retrospective cohort study explored the outcomes of the first 100 consumers supported by a new Australian Community Care Unit (CCU). The primary outcome focus was acute mental health service use (emergency department presentations, acute mental health inpatient admission days), and secondary outcome foci were accommodation independence and substance use. Results: When the 365 days before and after CCU support were compared, significant reductions in acute mental health bed days were observed (22 days, W = 3.373, p =.001); greater reductions were noted for those staying >182 days (31 days, W = 3.373, p =.001). Additionally, significant improvements in accommodation independence were found, (W = 3.373, p =.001). Conclusion: CCU consumers experienced reductions in acute mental health inpatient service use and improved accommodation independence. These observations are consistent with the intended functioning of the residential rehabilitation service. [ABSTRACT FROM AUTHOR]

Background: Current outcomes for mental illness are widely regarded as poor. Since the introduction of psychotropic medications in the mid 1950’s, previous psychosocial practices were minimized in favor of medication focused treatment. The majority of large U.S. state hospitals have closed with records destroyed or in storage, inaccessible to researchers. This creates barriers to studying and comparing outcomes before and after this shift in treatment practices. Aims: The study aim was to examine discharge outcomes in relation to length of stay and diagnosis in one U.S. state hospital. Methods: This case series study examined 5618 medical records of participants admitted to one state hospital from 1945 to 1954, the decade prior to adoption of psychotropic medications. Results: Of the 3332 individuals who left the facility, over half (59.87%) of first episode hospitalizations were discharged within 1 year, and 16.95% were hospitalized for more than 5 years. 46.17% of all admissions were discharged from hospital with no readmission. The most common diagnoses included schizophrenia, other forms of psychosis, and alcoholism. In the decade before the introduction of psychotropic medications, participants were often admitted for a single episode and returned to their homes within several years. Conclusions: Although limited to one site, findings suggest that discharge outcomes prior to psychotropic medication as a primary treatment for mental illness may be more positive than previously understood. [ABSTRACT FROM AUTHOR]

Recovery-orientated approaches have grown more and more common in psychosocial rehabilitation in Denmark, thus shifting the focus to the dynamic status of mental health issues that were historically regarded as chronic. This change has caused an important shift towards recognizing service users as humans with equal rights and possibilities. But the recovery-oriented approach is also complex and difficult to apply in practice. Drawing on phenomenological concepts of bodies and orientations in space, the paper discusses how bodies, which are perceived as queer, seek to reorientate themselves. The discussion draws on three empirical cases involving service users from fieldwork at housing facilities for people with severe mental health issues. The paper concludes that psychosocial rehabilitation housing facilities may benefit from adopting a broader perspective on body orientations because this contributes with a focus on service users as active agents who strive to inhabit space. [ABSTRACT FROM AUTHOR]

Objectives: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya. Method: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention. Results: Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement. Conclusions and Implications for Practice: This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed. Impact and Implications: This pilot study examined the feasibility and potential impacts of a psychosocial rehabilitation program for people with serious mental illness within a health care setting in Kenya. The program provided a more engaged and inclusive approach to mental health services, through which patients experienced a sense of possibility for their future lives and stakeholders became advocates for mental health recovery within their communities. Study findings also indicated improvements in recovery and increased connections with community among patients, and discussion of opportunities for improving mental health service delivery among stakeholders. [ABSTRACT FROM AUTHOR]

La multiplication des attentats terroristes ces dernières années a fait surgir l'horreur de la guerre en plein cœur de nos villes. Habitué à porter secours aux combattants sur tous les fronts et dans tous les milieux, le Service de santé des Armées est détenteur d'une expertise tant dans la gestion des situations de crise que dans l'accompagnement au long cours des patients blessés psychiques. L'objectif de ce travail est de rendre compte des dispositifs médicaux comme institutionnels mis en place aux différents temps du soin pour accompagner les militaires blessés. Nous espérons à partir de cette expérience pouvoir faire des parallèles et tirer des enseignements pour nos confrères chargés d'accompagner les victimes civiles d'attentats. When we listen to the testimonies of recent victims of attacks that have taken place in France in recent years, it is difficult not to draw parallels with war medicine. Since the initial exposure, which is characterized by its effect of surprise and stupefaction, the use of injurious and devastating weapons which leave painful and functional sequelae, the number of victims which increases the horror of the situation, it is of a battlefield that this description seems to come from. However, what characterizes the latter is the preparation of combatants to manage this type of eventuality and the operationality of a health service seasoned in crisis management. From the initial care in the theater, as close as possible to the fighting, to the conditioning of the wounded before their eventual evacuation, we will present to you in this work the care structures set up in the theaters of operation to provide assistance to the injured. We will see there that the psychological support of the combatants is integrated into this support and this from the battlefield. At the field hospital, brief management can be carried out associated with a few days of observation according to the principles of Salmon (immediacy, proximity, simplicity, expectation, centrality). From a distance, we will see how the accompaniment of the injured is thought out over time, not only in terms of care, but also in terms of administrative support in the steps aimed at recognizing and repairing the condition. Finally, we will present the first findings from the implementation of psychosocial rehabilitation tools. We hope that the course of care that emerges through this communication can inspire practitioners who accompany civilian victims of attacks. [ABSTRACT FROM AUTHOR]

During the Covid-19 pandemic, domestic violence (DV) in India rose exponentially. Therefore, the poor urban households in Kerala with the highest vulnerability call for urgent investigations and remedial actions. In this context, this study explored the problems of adolescents living with DV in deprived families, their risk factors, and protective factors. Based on the information gathered and the suggestions of social work experts, it further developed a framework for a school-based psychosocial rehabilitation (PSR), endorsing the role of school social workers. This study was conducted in a government-aided high school in the suburbs of Kochi. It gathered data from adolescent victims (n=12) of DV, their mothers (n=12), teachers (n=7), peers (n=30), and school counselor (n=1), subscribing to a generic qualitative inquiry. A theoretical thematic analysis was adopted for analyzing and drawing conclusions from the data. We recommend the PSR framework developed in the light of social support theory for testing and refining.

Introduction: Psychiatric rehabilitation can be considered a bidirectional technique, designed to allow patients to achieve their personal target, focusing on the individuals’ strengths and challenges related to these targets and also on the community organizations in which they will live them out. Unfortunately, psychiatric rehabilitation is too often not considered a first line treatment. Moreover, rehabilitation has been confused with a generic and rough practice, consisting of extemporary actions and aimless entertainments designed to fill “the time passing”. Methods: The aim of this study was to increase the knowledge and awareness about the state of the art of different systems of management and funding of psychosocial rehabilitation in the Italian “real-world” rehabilitative settings, using a specifically developed questionnaire. Results: The data obtained are positive for some aspects of the rehabilitation interventions, in particular for the use of validated tools for the evaluation and revision of projects and for the trend to work on a team, even though the scarcity of evidence-based rehabilitation interventions applied in Italian psychiatric services is less encouraging. Conclusion: This survey presents, at least partially, the “real-world” of rehabilitation in Italy so that we can lay the foundations for the definition of an updated, validated and shared network of what is implemented in the context of psychiatric rehabilitation. [ABSTRACT FROM AUTHOR]

This study examined the relationship between individual placement and support (IPS) employment specialists' time spent in the community and employment outcomes in the current digital age, featuring increased technology use and online hiring practices. The authors examined the relationship between employment outcomes and IPS employment specialists' time spent in the community at 78 sites in 2018 and 84 sites in 2019. The amount of time staff spent in the community was significantly and positively associated with better employment outcomes. These data support the continued importance of employment specialists' spending time in the community with employers and IPS recipients to achieve optimal outcomes for recipients. [ABSTRACT FROM AUTHOR]

Introduction: Within the history of psychology and phenomenology, people with lived experience of mental illness have often served as participants in research, but far less as co-researchers themselves. There is now a growing movement focused on "participatory" research, where people with lived experience directly contribute to various stages of the research process. This article presents such a qualitative, participatory research study, led by members of a large psychosocial rehabilitation clubhouse--Fountain House in New York City--and informed by phenomenological research principles. The study focused on collaboratively assessing and improving the clubhouse program for its members. Methods: A key feature of the project was the extent of lived experiencer involvement, for instance, in designing and conducting the study, and cowriting this research report. Members of Fountain House were trained in phenomenologically-informed research methods and developed a research study that focused on the quality improvement of their clubhouse program. Member researchers conducted a series of focus groups with fellow clubhouse members, generating qualitative data that were analyzed and written up by member researchers in collaboration with staff and university partners. Results: Overall, study findings place emphasis on the theme of action in members' experiences--both with respect to how action, agency, and valued activity were key drivers of meaning and recovery for people facing severe mental illness, and with respect to the key component of the research process itself [i.e., participatory action research (PAR)]. Four major subthemes emerged from the study. First, findings revealed how members with mental illness experienced the clubhouse as a "new hope" and "the place for me," to counteract their experience of inactivity, stigma, depression, and hopelessness prior to that point. Second, findings showed how, as members' life goals changed, so did the precise meaning and role of Fountain House in their lives. Third, findings portrayed members' need for, and pursuit of, transformation within the clubhouse space itself to provide more opportunities for meaningful work rather than what they viewed as merely busy-work. Finally, member researchers viewed their direct participation in this project as an opportunity to actively combat stigma, to be a driver of research, and to engage in what they viewed as a generative activity. Discussion: These action-oriented themes serve as a counter to the historical view of people with mental illness as merely passive experiencers of symptoms and passive recipients of mental health care. We discuss how the process and content of participatory research can help enhance the relevance of research for stakeholders' lives and contexts. [ABSTRACT FROM AUTHOR]

Objectives: Virtual reality and augmented reality have been used in psychosocial rehabilitation for adults with neurodevelopmental disorders in recent years, to provide functional training in a scaffolded and appealing manner. This systematic review attempted to evaluate (1) how virtual reality or augmented reality technology was deployed, when used as an intervention for adults with neurodevelopmental disorders; and (2) how virtual or augmented reality-assisted psychosocial rehabilitation programs impacted on the functional domains of community living, employment and social participation. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was adopted and a search of publications between June 2012 and June 2022 was carried out. The target groups were adults with schizophrenia/schizoaffective disorders, autism spectrum disorder, intellectual disabilities and attention deficit hyperactivity disorder. Interventions that targeted at least one functional domain were included. Results: The database search generated 1,267 records and 38 studies met the inclusion criteria. Three studies utilized augmented reality while the rest utilized virtual reality. The virtual scenarios were displayed in various ways, such as head-mounted displays, computer screens, mobile devices and cave rooms. A few studies also used features such as speech recognition, eye tracking and motion-capture device to provide real-time feedback to participants during rehabilitation. Eleven studies reported interventions that addressed community living, 15 studies addressed vocational skills and nine studies trained participants in social skills or social cognition. Three studies sought to improve quality of life using virtual scenarios to expose participants to various situations. Majority of these studies reported preliminary promising results, with improvement in the functional domains addressed. However, several studies had small sample sizes and many single-arm pretest-posttest studies were assessed to be of serious or critical risk of bias. Conclusion: Virtual reality and augmented reality are deployed in various ways to augment psychosocial rehabilitation for adults with neurodevelopmental disorders. Most interventions target skills training or strategy learning in the areas of community living, work and social participation. Preliminary positive findings of their effects on functional performance were reported. Larger and robust studies using ecologically valid outcome measures will be needed to establish their effects on real-world functional outcomes. [ABSTRACT FROM AUTHOR]

Cognitive remediation therapy (CRT) aims to optimise cognitive abilities of people who suffer from schizophrenia in order to improve their social adaptation. This therapeutic orientation was developed in psychiatry in the 1980s and 1990s, at a time when the disorder was being redefined as a neurocognitive deficit disorder. In this article, I describe CRT as an assemblage that lies at the intersection of multiple, overlapping theories and spaces of mental disorders and psychiatric care. To do so, I draw on 18 months of ethnographic research conducted in a French hospital unit dedicated to the development of CRT. I argue that the focus on cognitive health and cognitive abilities (or deficits) is not only redefining the logics of care and reshaping medical conceptualisations of schizophrenia, but it is also opening up to a new understanding of people's precarious life conditions, where emotional, biological, and cognitive fragility is intertwined with social and economic uncertainty. I then examine the extent to which psychiatrists have extended the goals of CRT to include psychosocial rehabilitation in order to mitigate not only the effects of cognitive deficits, but also the effects of limited social and professional integration encountered by patients. Finally, I conclude with a consideration of how CRT has become, for its proponents in France, a means to develop a policy and organisational project for French psychiatry. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVDs) pose a serious threat to global public health due to its high prevalence and mortality. Meanwhile, psychosocial rehabilitation (PSR) has gained popularity due to its beneficial effects on the cardiovascular system. There is substantial evidence that PSR is effective in lessening cardiovascular morbidity and mortality in CVD patients. To learn more about the development of PSR, 3,759 publications about PSR and related research were retrieved from the Web of Science (WoS) Core Collection from 1989 to 2022. Then, these publications were analysed using CiteSpace 6.1.R3 (64-bit) W version software in terms of country and institution-based analysis, author co-citation analysis (ACA), keyword analysis, and document co-citation analysis (DCA). The outcomes were elaborated in four aspects. First, the number of annual publications related to PSR has consistently increased in last three decades. Second, country and institution-based analysis showed that a few developed countries such as the United States, England and Canada, and institutions such as the Harvard University, the University of California, and the University of Toronto were the most active countries and institutions in carrying out PSR-related studies. Third, author co-citation analysis (ACA) revealed that Sherry L. Grace from York University had the highest number of publications (35). Her research majorly focused on optimizing post-acute cardiovascular care and its outcomes that contribute to the field of PSR. Frasure-Smith had the highest burst count of 41.39. His research mainly emphasized on the impact of psychological stress in acute myocardial infarction which is related to CVD. Document co-citation analysis (DCA) revealed that epidemiologic evidence was the predominant cluster in the domain of PSR. Fourth, Keyword based analysis showed that keywords such as coronary heart disease, cardiovascular disease, acute myocardial infarction and major depression made outstanding contribution to the PSR field. In conclusion, this study has provided useful information for gaining knowledge about PSR such as identifying potential contributors for researchers interested in the field of PSR, and discovering research trends in PSR, which can provide guidance for more extensive studies related to PSR in the future. [ABSTRACT FROM AUTHOR]

IntroductionPsychiatric rehabilitation can be considered a bidirectional technique, designed to allow patients to achieve their personal target, focusing on the individuals’ strengths and challenges related to these targets and also on the community organizations in which they will live them out. Unfortunately, psychiatric rehabilitation is too often not considered a first line treatment. Moreover, rehabilitation has been confused with a generic and rough practice, consisting of extemporary actions and aimless entertainments designed to fill “the time passing”.MethodsThe aim of this study was to increase the knowledge and awareness about the state of the art of different systems of management and funding of psychosocial rehabilitation in the Italian “real-world” rehabilitative settings, using a specifically developed questionnaire.ResultsThe data obtained are positive for some aspects of the rehabilitation interventions, in particular for the use of validated tools for the evaluation and revision of projects and for the trend to work on a team, even though the scarcity of evidence-based rehabilitation interventions applied in Italian psychiatric services is less encouraging.ConclusionThis survey presents, at least partially, the “real-world” of rehabilitation in Italy so that we can lay the foundations for the definition of an updated, validated and shared network of what is implemented in the context of psychiatric rehabilitation.

IntroductionWithin the history of psychology and phenomenology, people with lived experience of mental illness have often served as participants in research, but far less as co-researchers themselves. There is now a growing movement focused on “participatory” research, where people with lived experience directly contribute to various stages of the research process. This article presents such a qualitative, participatory research study, led by members of a large psychosocial rehabilitation clubhouse—Fountain House in New York City—and informed by phenomenological research principles. The study focused on collaboratively assessing and improving the clubhouse program for its members.MethodsA key feature of the project was the extent of lived experiencer involvement, for instance, in designing and conducting the study, and co-writing this research report. Members of Fountain House were trained in phenomenologically-informed research methods and developed a research study that focused on the quality improvement of their clubhouse program. Member researchers conducted a series of focus groups with fellow clubhouse members, generating qualitative data that were analyzed and written up by member researchers in collaboration with staff and university partners.ResultsOverall, study findings place emphasis on the theme of action in members’ experiences—both with respect to how action, agency, and valued activity were key drivers of meaning and recovery for people facing severe mental illness, and with respect to the key component of the research process itself [i.e., participatory action research (PAR)]. Four major subthemes emerged from the study. First, findings revealed how members with mental illness experienced the clubhouse as a “new hope” and “the place for me,” to counteract their experience of inactivity, stigma, depression, and hopelessness prior to that point. Second, findings showed how, as members’ life goals changed, so did the precise meaning and role of Fountain House in their lives. Third, findings portrayed members’ need for, and pursuit of, transformation within the clubhouse space itself to provide more opportunities for meaningful work rather than what they viewed as merely busy-work. Finally, member researchers viewed their direct participation in this project as an opportunity to actively combat stigma, to be a driver of research, and to engage in what they viewed as a generative activity.DiscussionThese action-oriented themes serve as a counter to the historical view of people with mental illness as merely passive experiencers of symptoms and passive recipients of mental health care. We discuss how the process and content of participatory research can help enhance the relevance of research for stakeholders’ lives and contexts.

Le trouble bipolaire est l'une des pathologies chroniques les plus invalidantes pour laquelle le délai d'accès au diagnostic et aux soins adéquats est de près de dix ans, ce qui a pour conséquences des comorbidités plus nombreuses, une plus grande sévérité de la maladie et une résistance aux traitements. S'inspirant des progrès de l'intervention précoce dans la psychose, il est essentiel d'optimiser la détection et l'intervention de patients présentant un trouble bipolaire afin d'améliorer leur pronostic. Cette revue narrative de la littérature des 30 dernières années synthétise les facteurs de risque et le syndrome à risque de transition vers un trouble bipolaire, concepts utiles en clinique pour le médecin traitant (généraliste ou psychiatre). Le modèle du staging dans le trouble bipolaire permet d'organiser les interventions spécifiques. Un cas clinique avec/sans détection et intervention précoces met en lumière les enjeux liés à la détection et l'intervention précoces dans le trouble bipolaire, ses avantages et défis et les données scientifiques actuellement disponibles pouvant guider les priorités d'interventions cliniques. Bipolar disorder (BD) is one of the most disabling chronic illness for which the delay in diagnosis and access to adequate care is about 10 years, with many consequences such as numerous comorbidities, greater illness severity and resistance to treatments. Building on advances in early intervention in psychosis, optimizing the detection of patients with BD and intervening early is essential to improve their prognosis. Identifying risk factors for BD would allow earlier detection of the target population with the aims of: (1) preventing the development of the disease, (2) delaying its onset and (3) improving the course through more timely treatment. We conducted a narrative review of the literature of the past 30 years on risk factors of BD and synthetising the concepts of at-risk of BD mental state, the staging model and associated interventions. These concepts are illustrated by a clinical case with and without early intervention highlighting the challenges of early intervention in BD and the scientific data currently available of use to the clinician (both general practitioners and psychiatrist). In addition to genetic and environmental risk factors (early trauma, substance use, etc.), vulnerability markers (cyclothymic or hyperthymic temperament, cluster B personality disorder) can guide the clinician towards the detection of at risk of BD mental state syndrome consisting of attenuated symptoms of hypomania, mood lability, early depressive episode with psychotic, severe or atypical characteristics. The delay in access to care attributable to the absence of "help-seeking", to self-stigmatization, or to unrecognized diagnoses (misdiagnosis with personality disorders or substance use disorders) weighs down the prognosis leading, as episodes cumulate over time, to incomplete remission of episodes with residual symptoms and significant functional decline. The use of validated tools and careful coordination of the various actors are assets for the early identification of subjects at-risk of transition to BD. Following the staging model, targeted primary prevention interventions (e.g., promotion of good sleep hygiene, stress management strategies) for at-risk individuals should be offered by general practitioner or other front-line mental health professionals (e.g., psychologist, nurse); early secondary prevention (for stage 1) should be provided by general psychiatric or general medicine services. Although no official guidelines for early intervention for BD are available yet, experts opinions are multiplying and supporting an integrated approach that maximizes young patient engagement. These integrated approaches aiming at symptomatic and functional improvement combine effective psychopharmacology and psychosocial interventions, including cognitive- behavioral therapy, approaches based on social rhythm, psychoeducation, relapse prevention, social and vocational recovery and family interventions. The scarcity of studies on the early stages of bipolar disorder limits the predictive value of risk factors and at-risk syndromes which remain to be validated. Prospective controlled studies are warranted to improve the prevention efforts and effective early treatment of bipolar disorder. [ABSTRACT FROM AUTHOR]