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A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

The purpose of this paper is to study the role of social factors that determine the length of stay in a mental hospital and also understand the main factors leading to the phenomena as a step to solve it.

A case-control cross-sectional observational study is performed which studies correlates for the lengthy stay in a mental hospital. The study population consists of two groups: Group A (94 patients), taken from the patients hospitalized for more than one year, further subdivided into schizophrenia and schizoaffective inpatient group and bipolar affective inpatient group; and Group B (94 patients), receiving their treatment at the outpatient clinic after being admitted for less than six months, this group was further subdivided into same categories as Group A.

The study showed that the positive score in positive and negative symptoms scale (PANSS) showed highly statistically significant (p<0.01) correlation with the length of hospital stay for the schizophrenic and schizoaffective patients in the inpatient group. The results showed no statistically significant difference (p>0.05) between the inpatient schizophrenic cases and the inpatient affective cases regarding the length of hospital stay.

The linear regression model was used to understand the predictors of increased length of hospital stay. The linear regression analyzing the scale data of schizophrenic and schizoaffective patients found that the length of hospital stay for the schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score. On the other hand, linear regression model for bipolar affective patients in the study found no statistically significant attributes of the length of hospital stay.

The study found that the length of hospital stay for schizophrenic and schizoaffective patients depends on the patient’s age and his positive PANSS score.

The need for this study stems from the large numbers of mental inpatients who have been lengthily admitted in mental health hospitals in Egypt, while trying to understand main factors leading to the phenomena as a step to solve it. The study found that there is a highly significant difference between inpatient group and outpatient group regarding the marital status, education level, and psychosocial class, with inpatient group having more single, illiterate, and very low social class cases.

Research in the area of chronic psychiatric hospitalization and its effect on the course and prognosis of mental illness is still scarce, especially in the Arab world; therefore, the research will open the door for further research efforts in the future with a larger sample of patients to study the pros and cons of deinstitutionalization taking into account the past experience of health systems in other countries.

The purpose of this paper is to assess the programmatic effectiveness of a post-incarceration support service, Jail In-Reach, to rapidly and permanently re-house newly released offenders with a documented history of homelessness, substance abuse and mental health disorders.

Data were obtained from SEARCH Homeless Services using the Adult Texas Recommended Assessment Guidelines survey instrument by the Texas Department of State Health Services. Repeated measures analysis of variance were performed to determine the effects of select predictors on the likelihood of permanent housing, which, for this research, is considered programmatic success.

Results indicate clients exhibited decreased risks of self-harm, employment problems, housing instability, co-occurring substance use, and criminal justice involvement as well as increased social support. Over half of the program participants either disappeared from the program or only secured temporary housing.

This was a small pilot project with limited generalizability. There have been no follow-up studies to examine long term permanent housing success. No data were available as to why participants dropped out of the program.

Intensive advocacy and support services provided pre- and post-institutional release could provide formerly homeless inmates with co-occurring substance abuse and mental health issues with positive outcomes.

Housing stability and connections to social service agencies are key factors for ensuring ex-offenders do not become re-incarcerated.

This paper contributes to the literature related to reducing homelessness among ex-offenders, to the effectiveness of critical time intervention-based programming, and the need for building social capital amongst this unique and underserved population.

Initiated by the service user movement, recovery-oriented practices are one of the keystones of modern mental health care. Over the past two decades, substantial gains have been made with introducing recovery-oriented practice in many areas of mental health practice, but there remain areas where progress is delayed, notably, the psychiatric inpatient environment. The peer support workforce can play a pivotal role in progressing recovery-oriented practices. The purpose of this paper is to provide a pragmatic consideration of how occupational therapists can influence mental health systems to work proactively with a peer workforce.

The authors reviewed current literature and considered practical approaches to building a peer workforce in collaboration with occupational therapists.

It is suggested that the peer support workforce should be consciously enhanced in the inpatient setting to support culture change as a matter of priority. Occupational therapists working on inpatient units should play a key role in promoting and supporting the growth in the peer support workforce. Doing so will enrich the Occupational Therapy profession as well as improving service user outcomes.

This paper seeks to provide a pragmatic consideration of how occupational therapists can influence mental health systems to work proactively with a peer workforce.

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering their natural environments, or were released into physically and emotionally unsafe homes (Bruns & Burchard, 2000; President's Commission on Mental Health, 1978; Stortz, 2000; Stroul & Friedman, 1986; U.S. Department of Health and Human Services, 1999). The cost of hospitalizing youth also became a policy concern (Henggeler et al., 1999b; Kielser, 1993; U.S. Department of Health and Human Services, 1999). For example, it is estimated that from the late 1980s through 1990 inpatient treatment consumed nearly half of all expenditures for child and adolescent mental health care although the services were found not to be very effective (Burns, 1991; Burns & Friedman, 1990). More recent analyses indicate that at least 1/3 of all mental health expenditures for youth are associated with inpatient hospitalization (Ringel & Sturm, 2001).

France, once a pioneer in psychiatry, is now sinking as its population faces major mental health challenges. This includes the 12 Million French individuals with psychiatric conditions, the lack of appropriate structures and the shortage of skilled mental health professionals, but it also leaves families in critical situations. The purpose of this study is to explore the carers’ caregiving experiences and to suggest ways to organise educational programmes to support mental health carers in France.

The research was conducted from January 2018 to November 2019. It included French carers of patients with mental conditions. Recorded semi-structured interviews were used and findings were analysed through an inductive thematic analysis and regrouped into key themes.

Participants had overwhelming negative representations of “mental illness”. The fact that they were excluded from participating in the patient’s health management further added to their misconceptions around mental disability, it limited their communication with their family and amplified their burdens.

There is an urgent need for carer empowerment; carers should be included in educational programmes, they should benefit from French Government subsidies and social-network assistance and receive quality assistance by trained mental health professionals. The critical situation of carers can only be addressed by combining these three steps and through the action of appropriate actors in the field of mental health, thus alleviating the current paradigm of psychiatric care in France.

Thousands of research papers regarding carers have been published in other countries. In addition yet, to the knowledge, only a few investigations on French mental health carers have been conducted to this day. The singularity of this research lies in the rare individual interviews, which provided us with first-hand testimonies of mental health carers in France. This data could be of vital aid for professionals and for policymakers when advocating for better support of carers in mental health.

Resource constraints at all levels of the criminal justice system as well as the lack of a widely accepted, validated screening scale have made it difficult to screen adequately for serious mental illnesses (SMI) in offender populations. This study examined the use of the K6 scale, a recently developed and validated screening tool for SMI, using a sample of past-year arrestees. Among the main findings were that 18% of the sample screened positive for SMI. In contrast, commonly used screening questions misidentified a large proportion of arrestees with SMI. Based on these findings, we recommend the use of K6 scale to more accurately identify offenders with SMI.

In the previous chapters, I set out a conceptual model of trauma-informed servant leadership and discussed servant leadership supervision for working with burnout, compassion fatigue and secondary trauma in employees within trauma related health and social care settings. In this chapter, I further extend servant leadership to the peer support principle in trauma-informed approaches (Substance Abuse and Mental Health Services Administration, 2014). The first part of this chapter will examine peer support work (PSW) and report on the outcomes associated with it. Then, servant leadership will be discussed and used to operationalise the principle of peer support as set out in trauma-informed approaches. A servant leadership peer support approach is put forward with a theoretical basis. This theoretical model has been slightly changed from the previous servant leadership approaches discussed, in order to represent the PSW role more accurately. However, as discussed previously, it is not the characteristics of the Servant leadership (SL) model that define the approach, rather the philosophy and desire to serve first. In the last section of this chapter, Martha Griffin brings the characteristics of this model to life using her vast experience and discusses some of the potential challenges faced by peers in training and practice.

The more disadvantaged members of society generally experience poorer outcomes following the development of mental ill-health. The purpose of this paper is to scope the literature and synthesise findings on the inequalities and mental health within secure mental health settings.

Six electronic databases were searched to identify relevant studies. These were included if they examined the association between inequalities and mental health in women’s secure mental health settings.

Of the 608 studies reviewed, 14 met the inclusion criteria. In these papers, violence and/or abuse were described as the most prevalent inequalities. The second most frequent group of inequalities identified were socio-economic. Only three published studies researched the impact of ethnicities. Physical health, alcohol abuse and a dysfunctional family upbringing were only mentioned in one of the studies. Gender identity, transitioning and sexual orientation was not considered in any papers. These are areas, which require further investigation to determine their specific impact in this setting.

This review highlights the dearth of high-quality research-based evidence underpinning an understanding of the impact of inequalities on women in secure mental health settings. The existing studies suggest that inequalities have a very particular impact and that intersectionality plays a key role. Further research is required to further understand how inequalities impact the lives of women in secure mental health settings.

The inequalities that women experience in relation to mental health need to be further researched in the context of intersectionality. There are also research gaps in terms of gender identity, sexual orientation and socio-economic background. Further primary research using a more complex methodological paradigm is required to explore these factors and their impact on mental health service provision.

The role of inequalities should be considered as part of an overall care package, including the experiences of adverse childhood experiences and this should contribute towards the development of a trauma-based care approach.

To the best of the authors’ knowledge, this is the first study to scope literature about inequalities experienced in women’s secure psychiatric settings considering intersectionality.

The use and abuse of alcohol is problematic for a person’s social and individual development. Maintenance of abstinence after detoxification programs is difficult for patients who experience a craving, and relapses during the course of the disorder are common. The purpose of this paper is to describe the socio-demographic and clinical features of alcohol-dependent patients by sex and alcohol use status and to analyze the percentage of patients who remained abstinent after 10 months of psychological treatment.

In total, 50 alcohol-dependent patients were enrolled (34 men and 16 women). The patients attended a psychological treatment program at a therapeutic community, Projecte Home Balears, Spain. This paper used the European Addiction Severity Index to collect socio-demographic data and data on alcohol and other drugs and the Trait Meta-Mood Scale-24 to measure emotional management.

Significant differences were observed in occupation (χ² = 9.9; p = 0.007) and duration of alcohol use (U = 137.000; p = 0.005) by sex and hospitalizations during the previous months (χ² = 15.477; p = 0.009) and type of chronic disorder (χ² = 7.6; p = 0.022) and duration (in months) of the longest period of abstinence after treatment in facilities (U = 219.500; p = 0.097) by alcohol use status. The survival analysis showed that 25% of relapses happened after 4.5 months of treatment; at 7.3 months, 50% of the sample remained abstinent.

Women had used alcohol for longer since age at onset than men. Furthermore, after 7.3 months of intensive therapy, 50% of alcohol-dependent patients were abstinent.