An Open Effectiveness Trial of a Multimodal Inpatient Treatment for Depression and Anxiety Among Adults With Serious Mental Illness

Fowler, J. Christopher; Clapp, Joshua D.; Madan, Alok; Allen, Jon G.; Frueh, B. Christopher; Oldham, John M.

doi:10.1080/00332747.2016.1196072

Cited by 12 publications

(7 citation statements)

References 38 publications

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“…If Iatrogenic effects are prevalent among BPD inpatients, results would indicate elevated severity of symptoms and impairment in functioning with marked spikes in symptom severity for BPD patients measured at bi-weekly intervals, and flat treatment response (higher initial symptom severity, limited improvement) relative to a reference inpatient sample. Similarly, remission rates should be substantially lower for the BPD cohort compared to a matched reference sample, particularly in light of the adverse impact that co-occurring personality disorders can have on remission rates from major depression (13), By contrast, a reference inpatient sample would be expected to evidence large effect size reductions in symptoms, and improvement in functioning, consistent with recent studies from this inpatient setting (14)(15)(16)(17). In the event that BPD patients evidenced equivalent rates of improvement and/or deterioration to the reference sample, we planned to explore baseline moderators of depression change (BPD diagnosis, substance use disorder, history of interpersonal trauma, emotion regulation).…”

Section: Hypothesessupporting

confidence: 58%

A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration

Fowler

Clapp

Madan

et al. 2018

Journal of Affective Disorders

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Twenty-five years ago it was assumed that adults with BPD could not benefit from psychiatric treatment. Today there are a number of effective evidence-based outpatient treatments for BPD, but beliefs about extended inpatient treatment have changed little. Current results indicate that extended inpatient treatment can result in significant and clinically meaningful symptomatic and functional improvement in BPD patients without iatrogenic effects.

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Section: Hypothesessupporting

confidence: 58%

A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration

Fowler

Clapp

Madan

et al. 2018

Journal of Affective Disorders

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“…This could contribute to women staying longer in hospital than men (Fowler et al, 2017). Participants in this study described becoming reliant on the safety of hospital surroundings because of being in hospital for too long.…”

Section: Feelings Of Powerlessness Have Been Identified Previously Inmentioning

confidence: 92%

“My life isn't my life, it's the systems”: A qualitative exploration of women's experiences of day‐to‐day restrictive practices as inpatients

Tully

Bucci

Berry

2022

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Sometimes someone needs to be in hospital because they are struggling with their mental health and need some extra support but being in hospital can also be a difficult experience. There are a lot of restrictions in place in hospital, like locked doors, rules to follow and not much choice about what happens to you. Other research has found that these restrictions can feel difficult and stressful for people and so more research is needed about this. We wanted to know what being in hospital felt like for women in particular. What the paper adds to existing knowledge? We interviewed women who were in hospital because of their mental health about what it was like for them in hospital. The women told us that they felt powerless while they were in hospital. They sometimes felt like they were being punished and this could affect their mood and could lead to them hurting themselves. They also said that they were not always listened to by staff, and they found it difficult being away from their family and friends while they were in hospital. The women also told us that being in hospital could sometimes help them to feel safe. What are the implications for practice? Women should be looked after in hospital in a way that helps them to feel in control of what happens to them. They should be supported to be able to go outside the hospital on leave, to keep in touch with their family and friends, and they should be listened to by staff. A project called “safewards” has suggested some ways for helping to make hospital wards safer. They have suggested that everyone should be clear about what the rules are when they go into hospital and ways that staff could communicate more clearly with the people they are working with. Our research supports using these techniques. Abstract IntroductionInpatient care often involves restrictive interventions such as seclusion and restraint and restrictive practices that limit the person's freedom, rights and daily activities. Restrictive practice has not been the explicit focus in previous research; however, it often appears as an important theme, with participants identifying it can have a detrimental effect on their well‐being. More research specifically on this topic in an inpatient setting is, therefore, needed. Women might be particularly vulnerable to adverse effects of restrictive practices compared to men as women generally occupy less powerful positions in society and more often experience abuse. AimsThe study aimed to explore women's experiences of routine restrictive practices in mental health inpatient settings. MethodsTwenty‐two women who were currently inpatients on mental health wards were interviewed about their experiences of restrictive practices in hospital. Interviews were analysed using thematic analysis. ResultsAn overarching theme emerged of powerlessness. Four key sub‐themes were also identified: restrictions perceived as punitive, having no voice, impact of restrictions on relationships and restrictions providin...

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“…Treatment outcomes are tracked every 2 weeks with a series of validated measures that patients and clinicians review together to assess progress in treatment and/or allow for data-driven modification to treatment plans 48–51. The minimum program duration is 8 weeks, which is based on previous research showing that this timeframe is effective for reducing symptomatic and functional burden among those with complex disorders, including those with significant somatic distress 42,47,52–55. Often, patients and providers agree to extend full or modified programming beyond 8 weeks as needed.…”

Section: Functional Rehabilitationmentioning

confidence: 99%

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

Orme

Fowler

Bradshaw

et al. 2022

Journal of Psychiatric Practice

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The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.

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An Open Effectiveness Trial of a Multimodal Inpatient Treatment for Depression and Anxiety Among Adults With Serious Mental Illness

Abstract: Rates of remission of depression and anxiety were greater than anticipated in this large cohort of adult SMI inpatients and may be related to intensity and length of hospitalization.

Cited by 12 publications

References 38 publications

A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration

A naturalistic longitudinal study of extended inpatient treatment for adults with borderline personality disorder: An examination of treatment response, remission and deterioration

“My life isn't my life, it's the systems”: A qualitative exploration of women's experiences of day‐to‐day restrictive practices as inpatients

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions

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