Search results

The emphasis on outcomes rather than process is an area that is receiving significant attention across the delivery of public sector services, and the question ‘so what?’ is increasingly being asked of service providers. With service user self‐direction being the focus of both provision and commissioning over the coming years, there will be an increasing need to justify the delivery and development of social care in terms of the end result. Strong leadership and vision is required across the public sector if this change, in both organisational culture and service user expectation, is to be achieved.Leadership as both a competency and an organisational function has been well researched within health and social care. The literature largely points towards the need for clarity and strength within the strategic vision, especially when considering the management of change and multifaceted partnerships, both of which are crucial to the delivery of social care outcomes. The actual detail of the outcome framework, and the means by which it can be measured and quantified, is still an area of debate, and as such the aim here is to highlight some of the benefits and barriers that may be faced as the reform of the social care system evolves, with a specific focus on the impact that leadership can have on the delivery of an outcome‐focused mental health social care serviceThe analysis of outcome‐focused organisations is a relatively new concept in health and social care, and as such this paper seeks to debate the evidence in terms of whether leadership contributes to better service user outcomes in mental health social care. Dynamics within organisations, professions and with service users are all key considerations in the achievement of positive outcomes, and the role of the leader is to empower the staff group to power share and move towards co‐production in order to embed choice, control and service user contribution in the overall philosophy and culture of mental health service provision and developments.The overall conclusions of this paper are that leadership is important in terms of shaping services, ensuring governance and promoting innovation, and as a result it is possible to suggest that leadership and positive outcomes do have a direct correlation.

The purpose of this paper is to address a knowledge gap on advocacy outcomes from mental health service users’ perspective, and the implications for evaluating advocacy impact. The studies discussed highlight challenges for measuring the outcomes of advocacy, but underline the importance of doing so, and of involving service users alongside other stakeholders in co-designing evaluation systems.

The paper uses findings from three qualitative studies of independent advocacy involving focus groups and interviews with: 30 African and African Caribbean men who were mental health service users; 90 “qualifying patients” in a study of Independent Mental Health Advocate services; and nine young women in children and adolescent mental health services (CAMHS).

A comparative analysis and synthesis of findings from three studies identifies four common dimensions: how mental health advocacy is conceptualised and understood; how service users define advocacy outcomes; wider impacts; and, user involvement in evaluating advocacy outcomes. Advocacy outcomes were conceptualised as increasing involvement, changing care and treatment and supporting personal development. There was evidence of advocacy acting to empower mental health service users, and of broader impacts on service regimes and policies. However, there was limited evidence of transformational impact. Evaluating advocacy outcomes is increasingly seen as important.

Few researchers have focused primarily on the perspectives of people using independent mental health advocacy, or on the experience of “advocacy as empowerment”, and none have done so across diverse groups. This analysis adds insight into the impact of independent advocacy. Data from empirical studies attest to the important role independent advocacy plays in modern mental health systems.

The purpose of this paper is to comprehensively identify and synthesize the mental health care provided through diverse community schools implemented in the USA.

Using PubMed, community school model websites and Google Search, we identified 21 community school models that publicly reported outcomes and conducted full review of these models. The authors also conducted e-mail and telephone communication with ten program directors and evaluators to gain insights into successes and lessons learned through implementing community school models based on community partnership.

Provision of mental health care though community schools leads to reducing school suspensions, disciplinary referrals, problem presentation, and risk behaviors, and improving school grades, personal responsibility, future aspiration, and family engagement.

Developing standardized outcome measure for the evaluation of mental health care provided through community school models is important to establish evidence that leads policymakers and practitioners into action. Information toolbox to guide mental health administrators and practitioners about future funding and partnership mechanisms for successful implementation and sustained mental health care through community school models can be useful.

This systematic literature review provides insights into the current practice and future direction in the provision and evaluation of mental health care through community school models and addresses concrete research and practical implications to guide mental health professionals.

Most research on the work conditions and family responsibilities associated with work-family conflict and other measures of mental health uses the individual employee as the unit of analysis. We argue that work conditions are both individual psychosocial assessments and objective characteristics of the proximal work environment, necessitating multilevel analyses of both individual- and team-level work conditions on mental health.

This study uses multilevel data on 748 high-tech professionals in 120 teams to investigate relationships between team- and individual-level job conditions, work-family conflict, and four mental health outcomes (job satisfaction, emotional exhaustion, perceived stress, and psychological distress).

We find that work-to-family conflict is socially patterned across teams, as are job satisfaction and emotional exhaustion. Team-level job conditions predict team-level outcomes, while individuals’ perceptions of their job conditions are better predictors of individuals’ work-to-family conflict and mental health. Work-to-family conflict operates as a partial mediator between job demands and mental health outcomes.

Our findings suggest that organizational leaders concerned about presenteeism, sickness absences, and productivity would do well to focus on changing job conditions in ways that reduce job demands and work-to-family conflict in order to promote employees’ mental health.

We show that both work-to-family conflict and job conditions can be fruitfully framed as team characteristics, shared appraisals held in common by team members. This challenges the framing of work-to-family conflict as a “private trouble” and provides support for work-to-family conflict as a structural mismatch grounded in the social and temporal organization of work.

Empowerment has been described as the ‘holy grail’ of health promotion. This article describes an evaluation of arts participation for people with mental health needs that both measured empowerment outcomes and explored the processes by which positive outcomes were achieved, through six qualitative case studies. For the outcomes study, 62 arts and mental health project participants returned a questionnaire, including a measure of empowerment, soon after joining their project and again six months later. The follow‐up questionnaire asked participants to rate the impact of their arts involvement on the issues addressed in the measure. Six diverse arts and mental health projects took part in the case studies. Interviews with project participants explored what they saw as the benefits of arts involvement and how these came about. Results from the outcomes study showed significant improvements in empowerment and were suggestive of a strong causal link with arts participation. Analysis of the case study interviews revealed five processes through which benefits relating to empowerment were brought about. We argue that psychological empowerment is in itself important for people with mental health needs. In addition, our case studies indicate that some arts and mental health projects do empower participants at a social as well as individual level.

The purpose of this paper is to systematically review quantitative research since 2000 on the effectiveness of residential therapeutic communities (TCs) for the treatment of substance-use disorders with reference to substance-use, crime, mental health and social engagement outcomes.

A systematic search with broad inclusion criteria resulted in the review of 11 studies. The studies investigated community-based TCs, as well as TCs modified for prisoners, prisoners transitioning to community living and TCs for individuals with co-occurring substance-use and mental health issues.

Results were analysed by comparing the findings of the studies under investigation, of which three studies investigated within-subjects outcomes, four compared TC treatment with a no-treatment control condition and four compared TC treatment with another treatment condition. Conclusion: consistent with previous systematic reviews of TCs, outcomes varied across studies but indicated TCs are generally effective as a treatment intervention, with reductions in substance-use and criminal activity, and increased improvement in mental health and social engagement evident in a number of studies reviewed.

Variability in outcomes suggests further TC research and research syntheses focusing on a second key research question in the evaluation of complex interventions – how the intervention works – could play an important role in understanding TC effectiveness, and for whom it is effective and in what contexts.

Although there is some variability in treatment populations included in this review, evidence reported in other studies suggests individuals with severe substance-use disorders, mental health issues, forensic involvement and trauma histories, will benefit from TC treatment. This is supported by the literature which has found a general relationship between severity of substance use and treatment intensity (Darke et al., 2012; De Leon et al., 2008) with outcomes further enhanced by self-selection into treatment and appropriate client-treatment matching (see De Leon, 2010; De Leon et al., 2000, 2008). The weight of evidence gleaned from multiple sources of research, including randomised control trials and field outcome studies (De Leon, 2010) suggests TCs are an important and effective treatment for clients in improving at least some aspects of their quality of life, specifically mental health and social engagement, and in reducing harmful behaviours, including substance-use and crime. Variability in treatment setting and populations reflect the real-world setting in which TC treatment is delivered, providing a multifaceted treatment modality to a complex population in variable circumstances.

The strength of the current study is that it provided a broad evaluation of TC effectiveness across a range of outcomes (substance-use, criminal activity, mental health and social engagement), and is therefore valuable in updating the current literature and providing context for future research in this area. It aimed to address a key question in evaluating complex interventions: whether they are effective as they are delivered. Findings suggest that TC treatment is generally effective for the populations of concern in reducing substance use and criminal activity and contributing to some improvement in mental health and social engagement outcomes.

Purpose: In the current work, we provide a portrait of heavy alcohol use, cigarette smoking, mental health, and suicide ideation by sexual orientation among a large sample of US adults aged 25 years and older.

Design/methodology/approach: We produce a repository of information on sexual orientation, substance use, mental well-being, and suicide ideation for adults aged 25 years and older using Behavioral Risk Factor Surveillance System (BRFSS) surveys for nine US states from 2011 to 2018. We establish baseline differences on these outcomes for gay, lesbian, and bisexual (GLB), relative to heterosexual, adults and then use regression techniques to adjust the estimates for important sociodemographic, socioeconomic, and relationship status variables.

Findings: Disparities by sexual orientation across substance use, mental health, and suicide ideation are concerning, some alarmingly so. Bisexuals, particularly women, face pronounced challenges across outcomes. Sexual minority men and women report significantly more poor mental health days and much higher odds of suicide ideation. To illustrate, gay men, lesbians, and bisexual men and women, relative to their heterosexual counterparts, have odds of seriously contemplating taking their own lives that are two to four times higher even after adjusting for relevant controls.

Originality/value: Existing knowledge connecting GLB identity and mental well-being has focused largely on adolescent and young adults. We provide a representative study on older adult differences across four different behavioral health outcomes by sexual orientation. The scale of the disparities we report here, and their implications for overall well-being across groups, deserves national attention and action.

Commissioning has been a central plank of health and social care policy in England for many years now, yet there are still debates about how effective it is in delivering improvements in care and outcomes. Social inclusion of people with experience of mental health is one of the goals that commissioners would like to help services to improve but such a complex outcome for people can often be undermined by contractual arrangements that fragment service responses rather than deliver holistic support. The purpose of this paper is to discuss a form of commissioning, Alliance Contracting, and how it has been allied with a Social Inclusion Outcomes Framework (SIOF) in Stockport to begin to improve services and outcomes.

The paper is a conceptual discussion and case description of the use of Alliance Contracts to improve recovery services and social inclusion in mental health care in one locality.

The paper finds that the Alliance Contracting approach fits well with the SIOF and is beginning to deliver some promising results in terms of improving services.

This is a case study of one area and, as such, it is hard to generalise beyond that.

The paper discusses a promising approach for commissioners to develop locally to guide service improvements and better social inclusion outcomes for people.

Rather than developing good services but fractured pathways of care across providers and teams, the Alliance Contracting approach potentially delivers more holistic and flexible pathways that ought to better help individuals in their recovery journeys.

This is the first paper to set out the use of Alliance Contracting and social inclusion measures to help improve services and outcomes for people experiencing mental health problems.

The purpose of this systematic review is to assess if there is a relationship between literacy abilities and mental health outcomes as reported in global literature. Fourteen percent of the global population has little or no literacy. Literacy skills impact on daily functioning and have been shown to impact on social outcomes. Whilst there has been research examining the potential association between literacy and mental health outcomes in specific populations, there has been no systematic review of this literature to date.

A systematic review was carried out using Embase, PsycINFO and PubMed to identify relevant papers that measured both literacy and mental health. Data relating to the association between literacy and mental health were extracted. The papers included were assessed for quality using a bespoke quality rating tool. A narrative synthesis describes the findings.

Nineteen studies from across nine countries were included in the analysis. Seventeen studies showed a significant association between literacy and mental health, those with lower literacy had greater mental health difficulties. Some papers reported factors that interacted with this association, such as age, gender, poverty and years of education.

To the best of the authors’ knowledge, this is the first systematic review to look at the global picture of literacy and mental health. It suggests there is a relationship between literacy abilities and mental health outcomes, highlighting the importance of healthcare professionals and services including identification of literacy needs within routine mental health practice.