User Perspectives on Professional Support and Service Use During Psychiatric Medication Discontinuation

Darrow, Sabrina M.; Pelot, Morgan; Naeger, Sarah; Ostrow, Laysha

doi:10.1007/s10597-021-00933-3

Cited by 3 publications

(2 citation statements)

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“…Senior staff seemed to show two distinct ways of managing this tension that placed a different emphasis on co-creation and autonomy or guidance in navigating protocols and legal structures. The former approach is most supported in current literature on the subject, where more paternalistic approaches risk increasing the mistrust or fear of judgement that can lead to the hiding of information or drop-out in some cases (Darrow et al, 2022). However, contextually embedded points emerging from the FGD may suggest that the views expressed in recent literature in their individualized narrative emerging from high-income countries neglect the vulnerability and dependency of others involved in the care relationship: the patient's family.…”

Section: Approaches To Patients' Identity and Autonomymentioning

confidence: 99%

“…This is echoed in the literature, where the balancing of the need for care and the freedom to choose is best achieved by fostering collaborative dialogues (Julius et al, 2009). The building of rapport is essential for this, where a strong relationship with a particular provider over an extended period of time greatly improves treatment adherence (Darrow et al, 2022;Julius et al, 2009). Furthermore, family inclusion or collaboration is a well-established priority in mental health policies and practice standards for (Wonders et al, 2018).…”

Section: Service Recommendationsmentioning

confidence: 99%

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Co-creating Mental Health services that prevent a descent into Homelessness

Rajan

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Homelessness is a global issue exacerbated by poverty, forced migration, rapid urbanization, and lack of affordable housing. In India, around 1.8 million people were homeless in the 2011 Census, with many forced to sleep on the streets or in unofficial settlements. The link between homelessness, poverty, and mental illness is complex and uncertain. The increased risk of mental illness from poverty creates a greater risk of homelessness, with approximately 25% of homeless people experiencing serious mental health issues in India. The Poverty, Mental Illness & Homelessness (PMIH) nexus is particularly relevant in India due to its large homeless population, high resource inequalities, and high prevalence of mental illness. This thesis aims to understand the factors influencing homelessness in the population attending the clinic and find ways to leverage them in improving services. It focusses on the experiential knowledge of diverse stakeholders, including primarily women with severe mental illness, and identify pathways otherwise left unseen. By addressing the research gap and focusing on the experiences of women with severe mental illness, the Banyan better solutions may be found to address the complexities of poverty, mental illness, and homelessness in India. The interactive research approach and mixed methods are used to address the persistent problem of PMIH in outpatient clinics. The study focuses on understanding factors of homelessness among people with mental illness and the service needs and usage of those accessing outpatient facilities. It finds that 32.65% of women with mental illness accessing outpatient clinics reported experiencing homelessness, with low educational attainment and relational disruptions being associated with higher odds. Eliminating gender-based differences in education could be a crucial policy and practice direction to reduce homelessness risks among women with mental illness. The study examines the lived experiences of women with mental health issues in Tamil Nadu who have been treated by The Banyan. Six themes related to protective factors against homelessness were identified: resilience emerging from trauma, treatment adherence, responsibility and purpose, family and relationships, spirituality, and employment and living space. 95% felt they were not at risk of becoming homeless, indicating hopefulness about future prospects. However, the majority struggled in terms of quality of life, highlighting the complex relationship between resilience and challenges. In part 2, the study discusses the service needs of clients during the Covid-19 pandemic situation, emphasizing the need for expanding mental health interventions to include individuals with psychosocial disabilities. Social work practitioners play a crucial role in crisis intervention, providing clinical services and coordinating interdepartmental liasoning work. Key recommendations include involving trained community-level workers, involving non-government organizations, creating a single window system for all social protection measures, including mental illness as an eligibility category in disability social protection schemes, and continuing useful mechanisms implemented during the pandemic in the post-pandemic world. In conclusion, this thesis emphasizes the integration of information and reflexive practice in preventing homelessness among vulnerable individuals, emphasizing the importance of social entitlement policies, greater flexibility in support and institutionalization of practices, and exploring the experiences of men and their narratives.

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Section: Approaches To Patients' Identity and Autonomymentioning

confidence: 99%

Section: Service Recommendationsmentioning

confidence: 99%

Co-creating Mental Health services that prevent a descent into Homelessness

Rajan

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Analysis of factors that promote the participation of patients with chronic diseases in shared decision making on medication: a cross-sectional survey in Hubei Province, China

Hu,

Feng,

Zong

et al. 2023

BMC Public Health

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Background Shared decision making (SDM) improves the health status of patients with chronic diseases, especially in the condition of poly-medicated patients. This study aims to find the factors associated with participation of patients with chronic diseases in SDM on medication. Methods A total of 1,196 patients with chronic diseases were selected in Hubei Province of China using cluster sampling methods. The random forest method was applied to rank the importance of independent variables by Mean Decrease Gini and out-of- bag (OOB) curve. Multivariate logistic regression was used to explore the independent variables’ effect direction and relative hazard. Results In this study, 5.18% of patients used patient-directed decision making (PDM, a decision-making model led by patients), 37.79% of patients used SDM (a collaborative decision-making model by patients and doctors), and 57.02% of patients used doctor-directed decision making (DDM, or paternalistic decision making, a decision-making model led by doctors). The random forest analysis demonstrated that the top 5 important factors were age, education, exercise, disease course, and medication knowledge. The OOB curve showed that the error rate reached minimum when top 5 variables in importance ranking composed an optimal variable combination. In multivariate logistic regression, we chose SDM as a reference group, and identified medication knowledge (OR = 2.737, 95%CI = 1.524 ~ 4.916) as the influencing factor between PDM and SDM. Meanwhile, the influencing factors between DDM and SDM were age (OR = 0.636, 95%CI = 0.439 ~ 0.921), education (OR = 1.536, 95%CI = 1.122 ~ 2.103), exercise (OR = 1.443, 95%CI = 1.109 ~ 1.877), disease course (OR = 0.750, 95%CI = 0.584 ~ 0.964), and medication knowledge (OR = 1.446, 95%CI = 1.120 ~ 1.867). Conclusion Most Chinese patients with chronic diseases used DDM during their medication decision-making, and some patients used PDM and SDM. The participation in SDM should be taken seriously among elderly patients with lower education levels. The SDM promotion should focus on transformation of patients’ traditional perception and enhance their medication knowledge.

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What factors promote the chronic disease patients’ participation in shared decision making of medication: a cross-sectional survey in Hubei Province, China

Feng

Zong

et al. 2023

Preprint

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Background: Shared decision making (SDM) improves the health status of patients with chronic disease, especially in the condition of poly-medicated patients. This study aims to find the factors associated with chronic disease patients’ participation in SDM of medication. Methods: A total of 1,196 patients with chronic disease were selected using cluster sampling method. The random forest method was applied to sort the importance of independent variables by Mean Decrease Gini coefficient, and the multiple logistic regression was used to explore the key factors associated with patients’ medication decision-making. Results: In this study, 5.18% of patients used informed decision-making (IDM), 37.79% of patients used SDM, and 57.02% of patients used paternalistic model. The random forest showed that the top 10 important factors are exercise, age, education, drinking, disease course, medication knowledge, gender, depression, job type, and compliance. The multiple logistic regression showed that patients over 65 years old, drinking always, with depressive symptoms, poor knowledge and compliance of medication are more likely to use IDM compared to SDM. Moreover, compared to SDM, those patients over 65 years old, exercise infrequently, with disease course over 10 years, depressive symptoms, poor medication knowledge and an occupation of manual labor were more likely to use paternalistic model. Conclusion: Patients’ health behaviors and medication knowledge significantly influenced the patients’ participation in SDM of medication. Related interventions should be executed to ameliorate the health behaviors and medication knowledge of patients with chronic disease to promote them participating in SDM of medication

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User Perspectives on Professional Support and Service Use During Psychiatric Medication Discontinuation

Cited by 3 publications

References 32 publications

Co-creating Mental Health services that prevent a descent into Homelessness

Co-creating Mental Health services that prevent a descent into Homelessness

Analysis of factors that promote the participation of patients with chronic diseases in shared decision making on medication: a cross-sectional survey in Hubei Province, China

What factors promote the chronic disease patients’ participation in shared decision making of medication: a cross-sectional survey in Hubei Province, China

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