People living with psychosocial disability: Rehabilitation and recovery-informed service provision within the second Australian national survey of psychosis

Abstract

Objective: People with psychosocial disability are an important, although often neglected, subgroup of those living with severe and persistent mental illness. Rehabilitation, provided through clinical and non-government organisations in Australia, may contribute to their personal recovery goals. We hypothesised that people with psychoses with the greatest disability and complex needs would receive services from both sectors, reflecting treatment and rehabilitation needs.Method: Participants in the 2010 Australian national survey of psychosis (n = 1825) were interviewed to assess demographic, functional, mental and physical health characteristics and service use in the previous year. Two subgroups were created and compared: those using services from community mental health with, and without, non-governmental organisation involvement. Group membership was predicted by hierarchical logistic regression using variables selected on a priori grounds. Usefulness of the final model was examined by calculating improvement over the rate of accuracy achievable by chance alone. Results:The model was statistically significant but fell just short of useful (criterion 71.6%, model achieved 70.6%). Four independent variables contributed uniquely to predicting whether participants received both services (never married, childhood trauma, group accommodation, poor global functioning) consistent with the hypothesis. However, severe dysfunction in socialising was less likely to predict membership of the combined services group when compared with no dysfunction (p = 0.001, odds ratio = 0.384, confidence interval = [0.218, 0.677]), as was current smoking compared with none (p = 0.001, odds ratio = 0.606, confidence interval = [0.445, 0.824]). Conclusion:Findings suggest services provided by non-governmental organisations are targeted to those with the greatest disability although targeting could be improved. A subgroup of people with psychosis and severe disability in community mental health services do not access non-governmental services. Their unmet needs for rehabilitation and recovery have important implications for future development of community mental health, including the non-governmental sector.

Recovery After Psychosis: Qualitative Study of Service User Experiences of Lived Experience Videos on a Recovery-Oriented Website (Preprint)

“…For example, in Australia in 2010, only 4.7% of people experiencing psychosis and connected to mental health services reported that they participated in peer-led support groups [4]. They could also be offered to people experiencing psychosis who have difficulty socialising [1], or to those who do not have paid employment and are therefore missing out on the contribution that work can make to self-identity and self-esteem in recovery [5,32].…”

“…This qualitative study was conducted in two Australian clinical community mental health services that provide psychiatric treatment and recovery-oriented services and four non-clinical community mental health services that provide psychosocial rehabilitation and recovery support [4]. Eligible consumer participants were over 18 years of age; with a diagnosis of a psychotic disorder; and had either completed use of the SMART website with a mental health worker employed by the SMART research program, or used the website for at least three months with their usual mental health worker.…”

“…Early experiences of psychosis often occur during adolescence to early adulthood, which irrespective of illness course can lead to persistent social disadvantage [2], so that close relationships, socializing with others, and employment can be difficult to maintain [2,[3][4][5]. Approximately 23% [2] to one third of people with psychotic disorders [1] also experience ongoing symptoms and disability, typically leading to continued engagement with mental health services [1].…”

A structured review of psychiatric rehabilitation for individuals living with severe mental illness within three regions of the Asia‐Pacific: Implications for practice and policy

“…Psychosocial disability often excludes individuals living with this disability from participating in the community through education, employment, recreation, relationships, and adequate housing (Harvey et al, ). Distinct from other forms of psychiatric care, rehabilitation focuses on helping such individuals achieve life goals that are impacted by symptoms and dysfunctions (Killackey, Harvey, Amering, & Herrman, ).…”

“…Of these, approximately 16 million Chinese citizens are affected by SMI (Tse, Ran, Huang, & Zhu, ). In Australia, 44% of those with SMI live with the most severe disability and accompanying complex multiagency support needs (Harvey et al, ). There is substantial evidence of the extent of suffering and human rights violations this vulnerable group face across the region (Chatterjee & Hashim, ).…”