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Words of Wellness
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Swarbrick, M. (March 1997). A wellness model for clients. Mental Health Special Interest Section Quarterly, 20, 1-4.
We conducted a quasi-experimental study of Compeer, which matches community volunteers and people with SMI to increase social
support. Seventy-five adults with SMI received community psychiatric treatments-usual (TAU) while 79 adults received Compeer
services plus TAU. Compeer clients reported significant improvements in social support and a trend towards improved subjective
well-being. After 6months, social support increased >1 SD for 13%, increasing to 23% at 12months, supporting qualitative
research suggesting the “active ingredient” in intentional friendships often takes more than 1year to develop. This subgroup
of responders showed significant gains in subjective well-being and reductions in psychiatric symptoms.
This article discusses how unemployment, poverty and social isolation make people sick with mental illness. If people with psychiatric rehabilitation can work, then the obvious companion postulate is that people with mental illness should work. Disability advocacy for employment has emphasized the untapped capacity of people with significant disabilities to make a contribution to our society as citizens through working. The argument that people with disabilities can’t work is essentially an empty one, as there are many examples that show that people with a wide variety of significant disabilities can work. The authors espouse the view that working is both a right and a responsibility for citizens with disabilities. The importance of high expectations has been well established as a tool in successful goal achievement and life advancement. The challenge for helpers is ensuring that this pressure of high expectation is initially borne more by rehabilitation staff members who are charged with assisting people with psychiatric disabilities to realize success, and not merely transferred through as an added burden to the clients they serve. As employment for individuals living with psychiatric disabilities becomes an acceptable norm and expectation, then the barriers of stigma, class bias, and discrimination diminish.
Emergency department visits and rehospitalization are common after hospital discharge.
To test the effects of an intervention designed to minimize hospital utilization after discharge.
Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card.
General medical service at an urban, academic, safety-net hospital.
749 English-speaking hospitalized adults (mean age, 49.9 years).
A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment.
Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment.
Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed.
This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report.
A package of discharge services reduced hospital utilization within 30 days of discharge.
Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.
This study examined the independent and interactive effects of common mental disorders and chronic pain conditions on employment and work outcomes among individuals under 65 years old.
Cross-sectional data were analyzed from the second wave of Healthcare for Communities (HCC2), a household telephone survey of U.S. civilian adults conducted in 2000-2001 (N=5,328). Common mental disorders were assessed by using the short-form version of the World Health Organization's Composite International Diagnostic Interview. Chronic pain conditions and employment outcomes were identified by self-report. Logistic and linear regression analyses were used to provide estimates for work impairment on the basis of the presence of a mental disorder or a chronic pain condition or both.
The interaction between presence of a mental disorder and presence of a chronic pain condition was significantly associated with no work for pay in the past 12 months (odds ratio=2.3, 95% confidence interval=1.2-4.2) and number of days of work missed in the past month because of health (regression coefficient=1.47, SE=.59). In stratified analyses this effect persisted for women but not for men. The presence of a mental disorder and the presence of a chronic pain condition were each independently associated with limitations in work and any work missed in the past 30 days because of health, although the interaction was not significant.
Mental disorders and chronic pain are each associated with work disability. Mental disorders are more strongly associated with some work disability outcomes when they are accompanied by chronic pain, especially among women.
Violence against women has long been considered a hidden health burden. Questions about violence have not been included in health surveys; hence, little is known about prevalence and the consequences for health in the general population. No national study has been conducted in Norway.
To estimate the prevalence of partner violence in Norway and the relationship between victimization and somatic health and depression and anxiety and post-traumatic stress symptoms.
Data collection was performed by Statistics Norway. Among a random sample of women aged 20-55 years, 2,407 women returned the questionnaire (63.3%), of whom 2,143 were ever-partnered. Selected demographic characteristics were obtained from registers.
In total, 26.8% of 2,143 ever-partnered women had experienced any violence by their partner during their lifetime, and 5.5% in the year before the study. Low educational level, being unmarried, separated or divorced, currently being unemployed, receiving social security benefits and having no children were significantly associated with reporting partner violence. Exposure to partner violence was associated with poor health, depressive and post-traumatic stress symptoms, gynaecological complaints, injuries, and disability, and remained so after controlling for age, education, unemployment, relationship break-up and low economic status.
Partner violence is common and was associated with a range of somatic and mental health problems. Thus, violence against women by their partners is an important public health concern.
Background:
Unemployment rates are high amongst people with severe mental illness, yet surveys show that most want to work. Vocational rehabilitation services exist to help mentally ill people find work. Traditionally, these services have offered a period of preparation (Pre-vocational Training), before trying to place clients in competitive (i.e. open) employment. More recently, some services have begun placing clients in competitive employment immediately whilst providing on-the-job support (Supported Employment). It is unclear which approach is most effective.
Objectives:
To assess the effects of Pre-vocational Training and Supported Employment (for people with severe mental illness) against each other and against standard care (in hospital or community). In addition, to assess the effects of: (a) special varieties of Pre-vocational Training (Clubhouse model) and Supported Employment (Individual Placement and Support model); and (b) techniques for enhancing either approach, for example payment or psychological intervention.
Search strategy:
Searches were undertaken of CINAHL (1982-1998), The Cochrane Library (Issue 2, 1999), EMBASE (1980-1998), MEDLINE (1966-1998) and PsycLIT (1887-1998). Reference lists of eligible studies and reviews were inspected and researchers in the field were approached to identify unpublished studies.
Selection criteria:
Randomised controlled trials of approaches to vocational rehabilitation for people with severe mental illness.
Data collection and analysis:
Included trials were reliably selected by a team of two raters. Data were extracted separately by two reviewers and cross-checked. Authors of trials were contacted for additional information. Relative risks (RR) and 95% confidence intervals (CI) of homogeneous dichotomous data were calculated. A random effects model was used for heterogeneous dichotomous data. Continuous data were presented in tables (there were insufficient continuous data for formal meta-analysis). A sensitivity analysis was performed, excluding poorer quality trials.
Main results:
Eighteen randomised controlled trials of reasonable quality were identified. The main finding was that on the primary outcome (number in competitive employment) Supported Employment was significantly more effective than Pre-vocational Training; for example, at 18 months 34% of people in Supported Employment were employed versus 12% in Pre-vocational Training (RR random effects (unemployment) 0.76 95% CI 0.64 to 0.89, NNT 4.5). Clients in Supported Employment also earned more and worked more hours per month than those in Pre-vocational Training. There was no evidence that Pre-vocational Training was more effective in helping clients to obtain competitive employment than standard community care.
Reviewer's conclusions:
Supported employment is more effective than Pre-vocational Training in helping severely mentally ill people to obtain competitive employment. There is no clear evidence that Pre-vocational Training is effective.