Peer delivered services in mental health care in 2018: infancy or adolescence?

Abstract

A second possibility is that antipsychotics have a normalizing effect on reward processing. Studies examining the neural response to rewarding stimuli in schizophrenia suggest that second generation antipsychotics are associated with intact response to reward outcomes in the ventral striatum 7 . Since individuals with schizotypy and youth at clinical high risk for psychosis are much less likely to be prescribed antipsychotics, the apparent paradox may reflect medication effects that become evident with more severe pathology.Third, schizophrenia is associated with more severe cognitive impairment and poorer insight into clinical symptomatology than schizotypy or clinical high risk states. It is possible that impaired cognition and insight are paradoxically protective, causing schizophrenia patients to have less awareness of hedonic deficits that may actually exist. Those with schizotypy and clinical high risk youth may be better able to accurately report their hedonic state because of higher cognitive function and insight.Fourth, environmental and stress effects may have a greater impact on youth at clinical high risk for psychosis and those with schizotypy. Schizophrenia is associated with impoverished quality of life, which for many patients reflects an environment and daily routine with restricted social, cognitive and affective demands. For individuals with schizotypy and clinical high risk youth, environments and daily routines are generally more complex and stressful. It is possible that this stress attenuates reward system responsivity. Supporting this, individuals with schizotypy seem to enjoy solitary activities, yet report activities with others as being taxing, stressful and unenjoyable 8 . Animal models and studies on humans support the notion of a "stress-induced anhedonia" 9 ; however, thisphenomenon has yet to be directly investigated in the schizophrenia spectrum. The schizophrenia spectrum anhedonia paradox harkens back to the seminal writings of P. Meehl 10 , who proposed that anhedonia is one of several polygenic potentiators that comprise the endophenotype for schizotaxia. Meehl distinguished between primary and secondary anhedonia. Primary anhedonia refers to one's hedonic capacity. This capacity is polygenically determined and dependent on neurotransmitter function and neural circuitry responsible for reward responsivity. Capacity varies on a continuous dimension, but may be taxonic at the extreme end. It seems that only a small proportion of schizophrenia patients would fall at the extreme end of the continuum, whereas substantially more individuals with schizotypy and clinical high risk youth would display primary anhedonia. Primary anhedonia may be a risk factor for the development of many forms of psychopathology, with schizophrenia being a less common outcome than others. Meehl also proposed the existence of "secondary anhedonia", which is measured via verbal report (through clinical interview or questionnaire) of one's hedonic response. He proposed that such reports are influenced b...

What Do Parents Expect in the 21st Century? A Qualitative Analysis of Integrated Youth Care

“…This is problematic, since families with multiple needs are a population from which we expect to benefit most from a supportive, informal social network [ 50 ]. There is a need for increased efforts of Youth Care professionals to organize informal support for these families, for example by introducing peers or experienced experts as support [ 51 ]. Including these experienced experts in integrated care has also been identified as a facilitator in previous research to integrated care from youth perspectives [ 23 ].…”

“…According to parents, this was due to long waiting times and a lack of clarity concerning the type of services offered by organizations. A lack of access and availability negatively influences the care processes, for example by lowering attendance for appointments [ 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 ]. Moreover, parental perceptions of waiting times differed greatly by severity: the more severe the problem, the more urgent the need for support and the longer the perception of the waiting time.…”

Recovery for all in the community; position paper on principles and key elements of community-based mental health care

“…The expertise of people who experience(d) mental ill health can be regarded as a third domain of expertise, in addition to scientific evidence and practical knowledge and skills. Peer experts are the living example that recovery is possible and they can support other service users in their recovery journey [81][82][83]. The term 'nothing about us without us' is applied.…”

“…In Europe lived experience has been acknowledged more and more as a domain of expertise [81], as shown in international and European policy documents and strategies of European service providers [83]. However, this is not always reflected in practice as only a few peer experts are paid and there is still a taboo on the selfdisclosure of professionals [85].…”

Primary Care Peer-Supported Internet-Mediated Psychological Treatment for Adults With Anxiety Disorders: Mixed Methods Study

“…The mental health sector has recently seen an increase in the use of peer support workers (PSWs) [ 17 , 18 ]. A peer support worker is a person with lived experience of mental health problems and rehabilitation who is employed in the mental health sector and becomes professionally active in recovery and support services for patients with mental health problems [ 19 - 21 ].…”