Community participation of individuals with psychiatric disabilities can be reliably measured using 2 methods of administration as an outcome in rehabilitation research and evaluation studies with this population. These individuals are engaged to varying degrees in a wide-range of participation areas in the community that are important, but most not to the degree that they desire. More intervention efforts are needed to increase the sufficiency of community participation.
Treatment adherence and nonadherence is the current paradigm for understanding why people with serious mental illnesses have low rates of participation in many evidence-based practices. The authors propose the concept of self-determination as an evolution in this explanatory paradigm. A review of the research literature led them to the conclusion that notions of adherence are significantly limited, promoting a value-based perspective suggesting people who do not opt for prescribed treatments are somehow flawed or otherwise symptomatic. Consistent with a trend in public health and health psychology, ideas of decisions and behavior related to health and wellness are promoted. Self-determination frames these decisions as choices and is described herein via the evolution of ideas from resistance and compliance to collaboration and engagement. Developments in recovery and hope-based mental health systems have shepherded interest in self-determination. Two ways to promote self-determination are proffered: aiding the rational actor through approaches such as shared decision making and addressing environmental forces that are barriers to choice. Although significant progress has been made toward self-determination, important hurdles remain.
The TUCP is a usable and relatively unobtrusive measure of community participation. Modest evidence found that more frequent events were recalled more consistently.
In 1998, a dialogue between mental health consumers and psychologists was sponsored by the Center for Mental Health Services. It is against this backdrop that the author briefly discusses her personal experience with serious mental health problems and how it has informed her clinical training and practice, especially in working with individuals with serious mental health problems and disorders. Using some of the overall recommendations of the 1998 meeting as guiding principles, the author reviews the literature on four topics that have become salient in her role as client—scientist—practitioner. Her experiential, academic, and clinical knowledge has led her to focus on how she can provide hope to her clients—patients in their recoveries and increase the use of first-person stories of individuals with mental disorders in both her practice and teaching. The discussion of therapist self-disclosure is reexamined in light of current research evidence and shifts in theoretical paradigms. Finally, readers are encouraged to examine the ongoing stigma associated with mental disorders perpetuated within the profession and look at experiential knowledge of mental disorders as an additional competence in the field of psychology rather than solely as an issue of professional competence or impairment.
Baseline data from a study of jail diversion services and in-jail behavioral health services were used to examine the differences in clients served by these two models of responding to people with co-occurring mental health and substance abuse problems in the criminal justice system. Clients of the diversion service had more acute psychiatric symptoms and were more likely to have a diagnosis of psychosis NOS. Clients of the in-jail service were more likely to have been on probation or parole in the past and to have received substance abuse treatment. Different service models may attract and serve different populations of clients. Diversion services may cast a wider net that includes clients who may not have otherwise been involved in forensic services.
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