Objectives: Serious mental illness is disproportionately common in people with epilepsy and contributes to complications and mortality. Few care approaches specifically target individuals who have epilepsy and severe mental illness. These investigators used an iterative process to refine an existing intervention and tested the novel intervention, Targeted Self-Management for Epilepsy and Mental Illness (TIME) in individuals with epilepsy and comorbid mental illness (E-MI) Methods: TIME was developed with input from a community advisory board and then tested for feasibility, acceptability and preliminary efficacy in people with E-MI, using a 16-week prospective randomized controlled design comparing TIME (N=22) vs. treatment as usual (TAU, N=22). Primary outcome was change in depressive symptoms, assessed by the Montgomery Asberg Depression Rating Scale (MADRS). Secondary assessments included global psychiatric symptom severity, seizure frequency, sleep patterns, quality of life, stigma, social support and self-efficacy. Results: There were 44 individuals enrolled, mean age 48.25 (SD = 11.82) with 25 (56.8%) African-Americans. The majority, (N=31, 70.5%), were unemployed and most (N=41, 95.5%) had annual income < U.S. $25,000. With respect to study retention, there were 36 individuals (18 in TIME, 18 in TAU) assessed at 12 weeks and 35 individuals (19 in TIME, 16 in TAU) assessed at 16 weeks. There was a significant effect for MADRS (p=0.036; effect size of 0.70), with lower MADRS at 16 weeks in TIME, while TAU MADRS did not change. Differences between most secondary measures were not statistically significant. Significance: The TIME intervention engages individuals to actively participate in self-management, and can reduce depression in E-MI. Given the high morbidity and mortality associated with epilepsy complicated by serious mental illness, additional research is needed to better identify how TIME might be implemented in routine care settings.

Background Self-management of Bipolar Disorder (BD) is challenging for many individuals. Material Interviews were used to assess perceived barriers to disease self-management among 21 high-risk patients with BD. Content analysis, with an emphasis on dominant themes, was used to analyze the data. Results Three major domains of barriers emerged: Individual barriers (psychological, knowledge, behavioral, and physical health); Family/ Community level barriers (lack of support and resources); and Provider/ Healthcare System (inadequate communication and access to care). Conclusions Care approaches providing social and peer support, optimizing communication with providers, and integrating medical and psychiatric care, may improve self-management of BD in this vulnerable population.

This study examined turnover of community mental health workers in 42 randomly selected mental health agencies in Ohio. The turnover rate in 2011 was 26 %. A regression analysis indicated that agencies with lower turnover offered higher maximum pay and were smaller in size, while those offering career advancement opportunities, such as career ladder programs, had higher turnover. The findings suggest that improving wages for workers is likely to reduce turnover. It is also possible that smaller agencies have lower turnover due to stronger relationships with workers and/or more successful hiring practices. Furthermore, turnover that occurs as a result of career advancement could have positive effects and should be examined separate from other types of turnover in the future.