Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India

Malla, Ashok; Iyer, Srividya N.; Rangaswamy, Thara; Padmavati, Ramachandran; Mohan, Greeshma; Taksal, Aarati; Margolese, Howard C.; Schmitz, N.; Joober, Ridha

doi:10.1192/bjp.2020.126

Cited by 39 publications

(52 citation statements)

References 32 publications

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“…The availability of the families of persons with FEP willing to work with the service providers can contribute to the reported better outcomes of FEP in some resource-poor settings, possibly by ensuring better adherence to treatment ( Mallaet al., 2020 ). A recent systematic review emphasised the importance of providing tailor-made interventions to engage families ( Selick et al., 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country

Vaitheswaran

Currie

Dhandapani

et al. 2021

SSM - Mental Health

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First Episode Psychosis (FEP) is a serious mental illness affecting adolescents and young persons. While many effective interventions are available, there has not been much research to understand the implementation of such interventions in India and other low- and middle-income countries (LMIC). We studied the implementation of an FEP intervention program in a specialist mental health facility in Chennai, India, using a well-established framework for doing so, the Consolidated Framework for Implementation Research (CFIR). We conducted 27 in-depth interviews with the service users (15 persons with FEP and 12 family caregivers of persons with FEP). We also conducted a focus group discussion with 8 service providers and in-depth interviews with 7 other service providers including those in the service management. A thematic analysis approach was used to identify emerging themes. First, we found CFIR effectively accommodated implementation challenges evident in LMICs; that is, it is transferable to LMIC settings. Second, we highlight barriers to implementation that include cost, limited human resources, cultural and professional hierarchy, divergence from evidence-based guidelines, and lack of awareness and stigma in the wider community. Third, we highlight facilitators for implementation such as, leadership engagement, the need for change that was recognized within the service, cosmopolitan perspectives derived from clinicians’ local and international collaborative experiences and expertise, compatibility of the intervention with the existing systems within the organization, accommodating the needs of the service users, and rapport developed by the service with the service users. Fourth, we propose a model of service delivery incorporating a task-sharing approach for first episode psychosis in resource restricted settings based on the feedback from the stakeholders.

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Section: Discussionmentioning

confidence: 99%

Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country

Vaitheswaran

Currie

Dhandapani

et al. 2021

SSM - Mental Health

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“…As part of a larger cross-cultural investigation of first-episode psychosis [ 28 , 29 ], this study was carried out with patients, families, and clinicians at two early intervention programs for youth with psychosis in Montreal, Canada and Chennai, India. Participants in Chennai were recruited from the first-episode psychosis clinic of the Schizophrenia Research Foundation (SCARF), a not-for-profit, non-governmental mental health organisation.…”

Section: Methodsmentioning

confidence: 99%

“…The Chennai and Montreal programs are open to referrals from a wide variety of sources and offer a similar protocol of intensive, phase-specific, two-year psychosocial (assertive case management, family interventions, family psychoeducation, therapy, etc.) and medical (flexible use of low-dose antipsychotic medication) treatments provided by a multidisciplinary team of clinicians (case managers and psychiatrists) to persons with first-episode psychosis [ 29 ]. Persons treated with antipsychotic medication for more than 30 days or with IQ below 70, solely substance-induced or organic psychosis, pervasive developmental disorder, or epilepsy are excluded from each program.…”

Section: Methodsmentioning

confidence: 99%

“…In the context of our longitudinal comparative study of 2-year prospective outcomes of first-episode psychosis in India and Canada [ 28 , 29 ], focus groups were conducted with patients, families, and clinicians, revealing differences in perceived stakeholder responsibilities across the two settings and between stakeholder groups. These varying perspectives on responsibility may contribute to differential outcomes across sociocultural settings.…”

Section: Introductionmentioning

confidence: 99%

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Whose responsibility? Part 1 of 2: A scale to assess how stakeholders apportion responsibilities for addressing the needs of persons with mental health problems

Iyer

Pope

Taksal

et al. 2022

Int J Ment Health Syst

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Background Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views of who should be responsible for these needs and there are no measures to assess this construct. This study’s objectives were to present the newly designed Whose Responsibility Scale (WRS), which assesses how stakeholders apportion responsibility to persons with mental health problems, their families, and the government for addressing various needs of persons with mental health problems, and to report its psychometric properties. Methods The 22-item WRS asks respondents to assign relative responsibility to the government versus persons with mental health problems, government versus families, and families versus persons with mental health problems for seven support needs. The items were modelled on a World Values Survey item comparing the government’s and people’s responsibility for ensuring that everyone is provided for. We administered English, Tamil, and French versions to 57 patients, 60 family members, and 27 clinicians at two early psychosis programs in Chennai, India, and Montreal, Canada, evaluating test–retest reliability, internal consistency, and ease of use. Internal consistency estimates were also calculated for confirmatory purposes with the larger samples from the main comparative study. Results Test–retest reliability (intra-class correlation coefficients) generally ranged from excellent to fair across stakeholders (patients, families, and clinicians), settings (Montreal and Chennai), and languages (English, French, and Tamil). In the standardization and larger confirmatory samples, internal consistency estimates (Cronbach’s alphas) ranged from acceptable to excellent. The WRS scored average on ease of comprehension and completion. Scores were spread across the 1–10 range, suggesting that the scale captured variations in views on how responsibility for meeting needs should be distributed. On select items, scores at one end of the scale were never endorsed, but these reflected expected views about specific needs (e.g., Chennai patients never endorsed patients as being substantially more responsible for housing needs than families). Conclusions The WRS is a promising measure for use across geo-cultural contexts to inform mental health policies, and to foster dialogue and accountability among stakeholders about roles and responsibilities. It can help researchers study stakeholders’ views about responsibilities, and how these shape and are shaped by sociocultural contexts and mental healthcare systems.

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“…The Chennai and Montreal programs are open to referrals from a wide variety of sources and offer a similar protocol of intensive, phase-speci c, two-year psychosocial (assertive case management, family interventions, family psychoeducation, therapy, etc.) and medical ( exible use of low-dose antipsychotic medication) treatments provided by a multidisciplinary team of clinicians (case managers and psychiatrists) to individuals with rst-episode psychosis (29). Persons treated with antipsychotic medication for more than 30 days or with IQ below 70, solely substance-induced or organic psychosis, pervasive developmental disorder, or epilepsy are excluded from each program.…”

Section: Research Contextmentioning

confidence: 99%

Whose responsibility is it to address the needs of persons with mental health problems? Development of a scale to assess how stakeholders distribute responsibilities across geo-cultural contexts

Iyer¹,

Pope²,

Taksal³

et al. 2021

Preprint

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Background Individuals with mental health problems have multiple, often inadequately met needs. Responsibility for meeting these needs frequently falls to patients, their families/caregivers, and governments. Little is known about stakeholders' views of who should be responsible for these needs and there are no measures to assess this construct. This study’s objectives were to present the newly designed Whose Responsibility Scale (WRS), which assesses how stakeholders apportion responsibility to persons with mental health problems, their families, and the government for addressing various needs of persons with mental health problems, and to report its psychometric properties. Methods The 22-item WRS asks respondents to assign relative responsibility to the government vis-à-vis persons with mental health problems, government vis-à-vis families, and families vis-à-vis persons with mental health problems for seven support needs. The items were modelled on a World Values Survey item comparing the government’s and people’s responsibility for ensuring that everyone is provided for. We administered English, Tamil, and French versions to 57 patients, 60 family members, and 27 clinicians at two early psychosis programs in Chennai, India, and Montreal, Canada, evaluating test-retest reliability, internal consistency, and ease of use. Results Test-retest reliability (intra-class correlation coefficients) ranged from excellent to good across stakeholders (patients, families, and clinicians); settings (Montreal and Chennai), and languages (English, French, and Tamil). Internal consistency estimates (Cronbach’s alphas) ranged from acceptable to excellent. The WRS scored average on ease of comprehension and completion. Scores were spread across the 1–10 range, suggesting that the scale captured variations in views on how responsibility for meeting needs should be distributed. On select items, scores at one end of the scale were never endorsed, but these reflected expected views about specific needs (e.g., Chennai patients never endorsed patients as being substantially more responsible for housing needs than families). Conclusions The WRS is a promising measure for use across geo-cultural contexts to inform mental health policies, and to foster dialogue and accountability among stakeholders about roles and responsibilities. It can help researchers study stakeholders’ views about responsibilities, and how these are shaped by and shape sociocultural contexts and mental healthcare systems.

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Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India

Cited by 39 publications

References 32 publications

Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country

Implementation of first episode psychosis intervention in India – A case study in a low-and middle-income country

Whose responsibility? Part 1 of 2: A scale to assess how stakeholders apportion responsibilities for addressing the needs of persons with mental health problems

Whose responsibility is it to address the needs of persons with mental health problems? Development of a scale to assess how stakeholders distribute responsibilities across geo-cultural contexts

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