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The provision of psychological support to caregivers is an important part of the role of the clinical staff working in palliative care. Staff knowledge and attitudes may determine their openness to referring caregivers to a psychological intervention. We recently developed a self-help intervention for grief and psychological distress among caregivers and were interested in exploring the extent to which staff knowledge and attitudes might affect future implementation. The aims of our study were to: (1) examine the acceptability of self-help psychological intervention for caregivers among palliative care clinical staff; (2) examine potential attitudinal barriers toward prolonged grief disorder (PGD) as a diagnosis and interventions for grief; and (3) bolster staff confidence in skills and knowledge in identifying and managing caregiver psychological distress.
An anonymous survey was distributed among clinical staff at two inpatient units and two community health services that assessed the acceptability of self-help interventions for caregivers, attitudes about PGD diagnosis and grief intervention, and staff confidence in skills and knowledge in assessing caregiver psychological distress.
Overall, clinical staff were positively oriented toward self-help for caregivers and intervention for grief. They were also basically confident in their skills and knowledge. While it was positive PGD attitudes that were associated with acceptability of self-help for caregivers, it was both positive and negative PGD attitudes that were associated more specifically with a willingness to refer caregivers to such an intervention.
Significance of results:
Our findings are useful in highlighting the issues to be considered in the implementation of a self-help intervention within the healthcare service. Clinical staff seemed positively oriented toward engaging with a psychological intervention for caregivers and likely to act as key allies in implementation.
Volunteer programs have been used to alter attitudes, provide long-term knowledge towards mental illness and increase the quality of life of consumers receiving volunteer services. Sixteen volunteers completed an 18-hour training program and in pairs worked with 11 consumers over 4 months. Sixteen volunteers completed training measures of knowledge and attitudes scales. Pre and post program quality of life and behavioural functioning measures were taken on 5 consumers. Volunteers maintained their knowledge of mental illness over 6 months and had significant increases in their comfort in interactions with people who have mental illness. Case managers, consumers and volunteers all reported high levels of satisfaction with the program but there were no significant changes in behavioural functioning or quality of life for consumers over 4 months of receiving volunteer support. High levels of client disability and the need for longer term follow-up were identified as factors needing to be addressed in future studies.
The effects of transferring 28 long-stay chronically mentally ill patients from a psychiatric hospital to community placements was evaluated. The Rehabilitation Evaluation Hall and Baker (REHAB; Baker & Hall, 1983) scale was used to assess clients' adaptive and maladaptive behavioural functioning at 12, 18 and 24 month intervals following the hospital baseline. Social contacts and inpatient readmissions were also assessed. The results showed that clients' general adaptive functioning and maladaptive behaviour, on average, remained stable across the hospital baseline and two year follow-up period. Clients with frequent social contacts were found to have significantly better adjustment on a number of the REHAB subscales and those who exhibited more maladaptive behaviour were more likely to be readmitted to a psychiatric inpatient unit. Overall the results were encouraging with relatively low readmission rates, however, approximately 10% of clients showed significant difficulty adjusting in the community. The implications of the findings for chronically mentally ill people and suggestions for community programmes are discussed.
Confidence in identifying different diagnostic categories of mental disorders by general health workers who provide the bulk of Papua New Guinea's (PNG) mental health care is vital for the country's provision of mental health care. Making a psychiatric diagnosis is complicated by PNG's diverse culture and estimated 800 distinct languages. These cultural-linguistic factors influence help-seeking behaviour and continued use of traditional treatment despite the introduction of western approaches to mental health care. The aim of this study was to determine the confidence of health workers in identifying and diagnosing different categories of mental health problems in this complex environment. A sample of 209 Papua New Guinea health workers from four geographic regions completed a questionnaire that assessed background levels of training and confidence in diagnosing a range of modern and culture specific diagnoses. Overall, respondents reported relatively little prior mental health training. Consistent with this were the relatively low levels of confidence for culture specific diagnoses (e.g. sorcery), but significantly higher levels of confidence with modern diagnoses (e.g. depression). The implications of the findings for training and provision of mental health care are discussed.
Informal caregivers of palliative care patients play an essential role in the coordination of care for patients during their final phases of life. However, undertaking a caregiving role can have enduring psychological consequences for caregivers and interfere with functioning. Studies have investigated a variety of factors associated with individual differences in caregiver psychosocial outcomes, but little is known about their relative impact, and there is a need for guiding models to support research in this area.
A review of the literature was conducted on factors influencing the psychological distress and grief of caregivers. Drawing from acceptance and commitment therapy (ACT) and Stroebe and colleagues' integrative risk factor framework, we developed a process model to describe individual differences in caregiver psychological distress and grief.
The model presents caregiver psychological distress and grief as functions of death attitudes and communication about death and dying, mediated by acceptance and valued living from an ACT perspective. An outline of the empirical and theoretical underpinnings for each component in the model is provided.
Significant of results:
The presented model is an inherently strengths-based model that is concordant with acceptance- and values- (ACT) based interventions to facilitate coping in caregivers.
Following a severe traumatic brain injury (TBI) there is a complex presentation of psychological symptoms which may impact on recovery. Validated treatments addressing these symptoms for this group of people are limited. This article reports on the protocol for a single-centre, two-armed, Phase II Randomised Control Trial (RCT) to address the adjustment process following a severe TBI. Participants will be recruited from Liverpool Brain Injury Rehabilitation Unit and randomly allocated to one of two groups, Acceptance and Commitment Therapy (ACT) or an active control (Befriending). The active treatment group utilises the six core processes of ACT with the intention of increasing participation and psychological flexibility and reducing psychological distress. A number of primary and secondary outcome measures, administered at assessment, post-treatment and 1-month follow-up, will be used to assess clinical outcomes. The publication of the protocol before the trial results are available addresses fidelity criterion (intervention design) for RCTs. This ensures transparency in the RCT and that it meets the guidelines according to the CONSORT statement. The protocol has also been registered on the Australian New Zealand Clinical Trials Registry ACTRN12610000851066.
This study examined the relationship between levels of group cohesion, defined as whole group relationships, and between-session therapeutic homework adherence in a multi-family group therapy (MFGT) for people with schizophrenia. Participants from 18 consenting families attending MFGT groups completed weekly homework adherence ratings, group cohesion and spontaneous between-session activity measures. Levels of group cohesion at each session were compared with measures of scheduled and spontaneous homework adherence reported at the next session. It was hypothesised that higher levels of group cohesion would be related to homework adherence and other spontaneous between-session therapeutic activity completed by group members. Results show higher levels of group cohesion were associated with higher rates of spontaneous between-session therapeutic activity. However, contrary to expectations no significant relationship between cohesion and scheduled homework completion was found. The implications of the findings for group processes and homework adherence are discussed.
This study reports on the relationship between stage of recovery and hope, meaning and responsibility for individuals diagnosed with severe mental illness. Methods: Seventy-seven people with a diagnosis of a psychotic disorder of at least 6 months' duration participated in the study. Participants completed the Self-Identified Stage of Recovery (SISR) scale, measures of component processes of recovery (Hope Scale; Positive Interpretation of Disease, SpREUK; Active Involvement, Personal Health Management Questionnaire (PHMQ) and the Recovery Assessment Scale-short (RAS). Results: Hope, meaning, Personal Confidence and Hope and Not Being Dominated by Symptoms varied significantly across stages of recovery; however, neither in a parallel nor linear fashion. Hopefulness and sense of meaning in relation to the experience of mental illness increase before personal confidence and resilience in the face of setbacks. Conclusions and implications: Symptoms appear to take less prominence in individuals' lives in later stages of recovery. Greater insight into the relationship between stage of recovery and component processes may allow for more targeted recovery-oriented support for individuals at different stages of recovery.
Archival data from a cross-sectional survey of two cohorts of community-residing New Zealand adults (n = 157; n = 141) was analysed to examine social attitudes towards people with mental illness in a historical period associated with the establishment of a community mental health facility. Participants completed the Opinions about Mental Illness (OMI; Cohen & Struening, 1959), and the Comfort in Interaction Scale (CI, Beckwith & Mathews, 1994); the latter a measure of level of prior contact with people with mental illness. Across cohorts, the OMI Mental Hygiene subscale and the CI scale had significant variability. Older participants endorsed more Authoritarian, Social Restrictiveness and Interpersonal Ideology attitudes in their perception of people with mental illness than younger participants. Data supported the hypothesis that attitudes towards people with mental illness were influenced by social attitudes, and by opportunities to interact with people with mental illness in work settings.
There is now wide agreement that people with severe mental illness can be adequately treated and cared for in the community, provided back-up hospital care is available when needed. Another important development has been the recognition that clinical treatment and care is insufficient for recovery and restoration of role functioning following illness onset, and must be supplemented by evidence-based practices in psychiatric rehabilitation. This article describes how allied health professionals can lead recovery oriented approaches that incorporate evidence-based forms of psychiatric rehabilitation. Family psychoeducation and supported employment are provided as examples of such evidence-based practices that require wider implementation.
The Helping Hands program commenced in 1999 and partners volunteers with mental health consumers for support and to increase social contact, recreational and friendship opportunities. The aim of the present study is to describe the evolution and sustainability of the program over the first 6 years. A description of consumers accessing the program using recovery-oriented measures and traditional measures of behavioural functioning is also provided. Service data was collected on the development of the program, service utilisation, volunteer participation and funding patterns. Cross-sectional measures of recovery and baseline and follow-up Health of the Nation Outcome Scales (HoNOS) were collected on 27 participants. Results showed that the Helping Hands program has evolved significantly since start-up with the development of numerous recreational, health and support groups and 48 active volunteers and 62 active clients. Consumer feedback indicates that the service increases the quality of life of participants considerably. Current clients showed less severe disability at referral than did the original group. There were improvements in the area of relationships on the HoNOS for those who had baseline and follow-up measures. The high volunteer participation rates and positive consumer outcomes represent significant value in return for the modest level of funding.
Few studies report long term follow-up of community gatekeeper training programs that aim to facilitate help-seeking for suicide and there are none in Aboriginal communities. This study aimed to determine long term effects of the Shoalhaven Aboriginal Suicide Prevention Program (SASPP), which used community gatekeeper training as its primary strategy. Following consultation with the Aboriginal community, a brief questionnaire and semi-structured interview was completed by 40 participants who attended a community gatekeeper workshop 2 years earlier. Fifteen of the 40 participants stated that they had helped someone at risk of suicide over the 2-year follow-up period. Intentions to help and confidence to identify someone at risk of suicide remained high. A significant relationship was found between intentions to help prior to the workshop and whether participants had actually helped someone at risk of suicide. Correlations suggested a link between intentions to help, and subsequent help provision. However, it is unclear whether workshop attendance contributed to this effect. Future prevention programs need to be customised to specific Aboriginal communities to reduce barriers to helpseeking behaviour.
Fifty patients with myocardial infarction were recruited from a hospital based Cardiac Education and Assessment Program (CEAP) in Sydney, Australia. The Exercise Motivation Inventory-2 (EMI-2) and the Depression, Anxiety and Stress Scale (DASS) were administered prior to commencement in the program and re-administered by telephone interview at 5-month followup. Four exercise adherence measures were completed: attendance, exercise stress test, self-report ratings and a 7-day activity recall interview. There was a 46% adherence rate for MI patients during the hospital based CEAP. Of those individuals who completed CEAP, 91% obtained functional improvement on the exercise stress test. For the 38 patients who were followed-up by telephone interview at 5 months, 71% were exercising according to CEAP prescription. Higher levels of anxiety were associated with lower levels of self-reported exercise adherence. The 3 strongest motivations for exercise in this group of MI patients were all health related; wanting to be free from illness, maintaining good health and recovering from the effects of coronary heart disease. The discussion highlights the implications of these findings for cardiac rehabilitation programs and the need for empirically driven guidelines for measuring exercise adherence.
Seventy-seven mental health professionals completed a 3-day cognitive behavioural training course for managing hallucinations and delusions in schizophrenia. A questionnaire measuring attitudes and empathy towards working with people who have these symptoms was administered before and after the course. Significant increases in feelings of adequacy, legitimacy, employment related self-esteem, and expectations of work satisfaction were observed after the course and participants displayed high levels of motivation for working with this clinical population at both time points. In addition, the participants showed significant increases in perceived empathy for the experience of hallucinations and delusions. This was a predicted outcome as the course included exercises designed to enhance therapists' understanding of the subjective experience of psychotic symptoms. Empathy is recognized in the wider psychotherapy outcome literature as a therapeutically important variable that influences the formation of a therapeutic alliance but it is a relatively unexamined construct in CBT for psychosis. Further investigations in this area will potentially enhance psychological treatment delivery and subsequent outcomes for people who experience hallucinations and delusions. Furthermore, explication of such “non-specific” therapeutic factors may help to explain some of the transient but beneficial effects of unstructured “control” therapies observed in recent CBT for psychosis outcome trials.
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