How the care giver attempts to cope with these consequences can have an effect on their relative. & Vlaeyen, J.W.S. Until recently, there were thought of as relatively independent and separate problem areas. 59, 902-908 Frankel, E.H. (1996) Dissociation: The Clinical Realities. (2000) Compliance and psychological reactance in schizophrenia. Evidence indicates that when such attitudes are held problems of substance misuse are often overlooked and not dealt with or referred on (Howard & Chung 2000). (1999) Postgraduate Journal Club as a Means of Promoting Evidence-Based Obstettics and Gynaecology. Results of the training demonstrated increased confidence of care co-ordinators in working with substance misuse and mental illness. Different types of complexity are discussed with a more detailed examination of a specific complexity; the relationship between substance misuse and psychosis (dual diagnosis). Treatments planned vary depending on group or individual needs but all try to determine psychological treatments and social interventions that are most effective in promoting wellness. It also supports those who may not have proficient skills at critical appraisal of research. & Lewis, S. (2003) Cognitive Behavioural Therapy and Motivational Intervention For Schizophrenia and Substance Misuse: 18 Month Outcomes of a Randomised Controlled Trial. There was also a small difference in the percentage of days of abstinence between the two groups with the treatment group proving more favourable. experience positive symptoms. Psychosocial Assessment: Impacting Care Planning & Intervention Presented by: Paige Hector, LMSW Debbie Lane, MSW Objectives Identify crucial components of psychosocial assessment Demonstrate how psychosocial assessments should impact the care plan Biopsychosocial-spiritual Perspective Physical or medical aspects of ourselves (bio) The term is generally used to include both models of service delivery such as assertive outreach and specific interventions, for example Family Intervention and Cognitive Behavioural Therapy (CBT). Laura’s case was exacerbated by the use of illicit substances and alcohol demonstrating how substance misuse can add greatly to the complexity of an individual. British Journal of Psychiatry. The opportunities and challenges of contemporary policy for people with complex mental health needs: Report of CSIP Eastern and SPN Study day. It should be noted that any form of therapy would only be one aspect of interventions. (1995) Substance Abuse and Family Relationships of Persons with Severe Mental Illness. Although the evidence for these are still limited and more research is required also a number of barriers make the implementation of such interventions difficult. (2004) Measured success: A scoping review of evaluated psychosocial interventions training for work with people with serious mental health problems. Providing a good rationale of why care givers should be informed and how doing this can help the situation. As previously mentioned the aim of PSI is to reduce stress or to help cope with stress better; therefore, it can be seen how the Stress Vulnerability Model plays a central role in providing psychosocial interventions. Psychiatrists commonly prescribe drugs to manage symptoms of mental disorders. Journal of Obstetrics and Gynaecology. Supervision also allows a forum for dysfunctional attitudes to be explored and discussed. The topics covered within CBT sessions for those with dual diagnosis differs from that of someone who does not use substances. Potential barriers may occur when implementing these newly acquired skills and knowledge due to feelings of diminished confidence as part of the learning process (Atherton 2008). Baker et al (2006) suggest both this trial and the one carried out by Barrowclough and colleagues suggest improvements in substance misuse. Often called talk therapy, psychotherapy is when a person, family, couple or group sits down and talks with a therapist or other mental health provider. One of which are those with dual diagnosis as services have difficulty providing for their multiple needs. Psychosocial interventions are not in essence anti-pharmacological, but are equally effective as pharmacological treatment in some disorders, e.g. The following are examples of interventions that are designed to enhance smoking cessation when combined with psychological interventions and/or nicotine replacement therapy: Audiotapes & Relapse Prevention Clients are provided with computer-controlled audio taped therapeutic messages called "digital therapists," and they are encouraged to listen to the recording any time they may feel tempted … London: Department of Health, Care Services Improvement Partnership, Department of Communities and Local Government. A small change in one part of the web of interacting systems may lead to a much larger changes in another part through amplification of effects. These complexities have been recognised by the government and national drivers have been produced to guide mental health professionals and services to enable delivery and provision of the best services. British Journal of Clinical Psychiatry. The findings it … NIMHE: Trent WDC Brown, G.W., Monck, E.M., Carstairs, G.M & Wing, J.K. (1962) Influence of family life on the course of schizophrenic illness. Psychosocial interventions can hold the key to communicating and engaging with clients and families. Rankin & Regan (2004) discuss how the term complexity means that there is no generic complex needs case. Atherton, J.S. (Eds) (2005) Oxford Dictionary of English. They are said to produce the least biased results as random samples are used to minimise the possibility of error in design and conduct (Roberts, 1999). Advances in Psychiatric Treatment. Clinical Psychology (PSY401) VU. For example the impact of experiencing voices does not end here but effects other areas of a person’s life (see Table 2). “… a range of evidence-based interventions for people with psychosis and their care givers. The rationale for selecting this topic is derived from personal working experience with mental health service users. ; Max, O.J. The Biopsychosocial model was first conceptualised by George Engel in 1977, suggesting that to understand a person's medical condition it is not simply the biological factors to consider, but also the psychological and social factors . They continue recommending that nurses working within the substance misuse field should be trained in picking up such information. Psychosocial interventions refer to different therapeutic techniques, usually classed as nonpharmacological (not involving medication), that address the psychological aspects of an individual or group and consider the persons or groups situation from a societal, familial perspective. Orders:20 We can create an original paper just for you! • Be aware of the paradigm shift from managing BPSD to a person-centred approach that focuses on the patient's well-being and quality of life. In addition to this complexity ‘The national service framework of mental health’ (DOH 1999a) identifies patients whom misuse substances and have a diagnosis of serious mental illness as a population of greater risk of stigmatisation and exclusion from existing service provision. Cognitive behavioral therapy has become a popular treatment type, especially due to its relatively short duration. Ha ha. Often a person with dual diagnosis is only marginally engaged with services but may have regular contact with their families who provide financial and psychological support (Thylstrup & Johansen 2009). The use of psychosocial interventions (PSI) is advocated in national drivers such as ‘Schizophrenia: Core intervention is the treatment and management of schizophrenia in adults in primary and secondary care’ (NICE 2009). Interventions can be evolved for a single person in treatment for a variety of diseases, best models of treatment may be suggested for groups that share a common illness like schizophrenia or erectile dysfunction, or psychologists and others develop interventions for groups that are undergoing great stressors, like being in the midst of a war or recovering from a natural disaster. This important report provides a synthesis of evidence on the application of specific supports as early intervention for people experiencing psychosocial disability. A relative of a person with a diagnosis of schizophrenia may experience negative consequences in many areas including: emotionally, socially, psychologically and economically, as they adjust to their new role as a care giver (Reader 2002). This discussion is then focused on particular interventions for dual diagnosis that show promise for enhancing service user and carer experience, namely a integrated treatment approach of cognitive-behavioural therapy, motivational interviewing and family therapy. Tricia lives in Northern California and is currently The services do not necessarily need to meet all the needs of the individual but have mental health professionals that are effective case managers. This report aims to explore the term complexity in relation to individual cases of those with serious mental illness. The team consists of case managers, peer support workers, psychiatrists, social workers, psychologists, nurses, and vocational specialists. Even if people are aware of the evidence base; if they are not trained, then they are not likely to provide efficient treatment. Examples from clinical practice are given to illustrate potential barriers, and outcomes when implementing such interventions with service users with complex needs and their caregivers. This report does not measure impact on care giver outcomes. However, the results do show promise for care givers within the treatment programme, showing some trends towards better personal outcomes. When non-medical therapy is an option, that is the way to go. This supports the recommendations of Graham et al (2003), Abou-Saleh (2004), and Graham et al (2006) where effective service delivery means teams are developed to meet tailored needs of particular client groups i.e. In reality it is not possible for all service users with dual diagnosis to receive interventions from a cognitive behavioural therapist. Leading to people losing contact with their friends and families. 26(5), 531-556 Jackson, H.J., McGorry, P.D., Killackey, E., Bendall, S., Allott, K., Dudgeon, P., Gleeson, J., Johnson, T. & Harrigan, S. (2008) Acute-phase and 1-year follow-up results of a randomised controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project. increased burden, increased expressed emotion Within literature the most commonly reported reason that people with serious mental illness use illicit drugs is to self medicate, for example, to relieve negative symptoms of schizophrenia (Littlejohn 2005). 161, 1334-1349 Miller, W. & Rollnick, S. (2002) Motivational Interviewing: Preparing People to Change Addictive Behaviour (2nd Edn). Nordic Journal of Psychiatry. Thus ensuring that if people do not have the skills to deal with such complex needs then they have the skill to recognise this and re-refer to other services. For example the interventions explored in this report (CBT, MI and FI) display potential for improving service users and care givers outcomes and optimising service delivery. From experience and evidence it could be concluded that the majority of mental health professionals are not fully trained in delivering cognitive-behavioural therapy, amongst other interventions to those with dual diagnosis. Demonstrating some of the factors that add to an individual’s complexity. ; McGovern, D.; Mueser, K.T. Mental Health Practice. Individuals and their immediate social relationships are embedded within wider social political and cultural systems which can influence outcomes in entirely novel and unpredictable ways. 194. This book provides examples of psychosocial interventions: taking into consideration the individual, social and environmental aspects of the person's life. 62(1), 81-90 Littlejohn, C. (2005) Links Between Drug and Alcohol Misuse and Psychiatric Disorders. (1996) Family Support for People with Dual Disorders. Luke’s Mother had now had enough and didn’t want Luke back home. There are many types of psychosocial interventions, including: Patient education (for example, helping patients become active in managing their own care) Coping support through psychotherapy or counselling Group therapy and stress reduction programs … Haddock et al (2003) suggest more intensive work should be done with families due to the high rates of expressed emotion. In essence brokering out to other services and not trying to meet all of the services users needs alone. Luke managed to do this for a few weeks and was admitted to the rehabilitation unit. As mentioned within this report it is very difficult for mental health professionals to keep up to date with current evidence based practice due to the large amounts published each year. Schizophrenia Bulletin. With a view to provide evidence based interventions for dual diagnosis to those even when not in a specialised team. Even though the diseases of mental illness and drug abuse [...], The Center Cannot Hold is an awe-inspiring book about Elyn Saks and her life with Schizophrenia. The term is generally used to include both models of service delivery such as assertive outreach and specific interventions, for example Family Intervention and Cognitive Behavioural Therapy (CBT). British Journal of Psychiatry. Cochrane Database of Systematic Reviews, Issue 4. This report has aimed to discuss the term complexity. •Psychosocial wellbeing: The positive state of being when an individual, family or community thrives. For just about any disease treatment, a number of psychosocial interventions are available, and psychologists and others try to determine which ones are most effective. ; Kolodziej, M.E. & DiClemente, C. (1986) Towards a Comprehensive Model of Change. Again, adding to the complexity of individuals that because one individual responds one way to an event does not mean all will. Psycho-education with Laura and her Father. (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. Comprehensive Psychiatry. The aim of CBT is to lessen distress caused by negative feelings; it attempts to do this by changing the thoughts (cognitive) and beliefs that underpin them. This report aims to critically appraise psychosocial interventions (PSI) that are utilised when working with complex cases. Examples of Psychosocial Assessment We gives you two examples of psychosocial assessments―one is a brief example of what it is like, while the other is more detailed. The family dynamics of a person with a dual diagnosis is often impacted greatly due to the complexities discussed earlier and there is growing evidence to suggest how family involvement can have positive impacts on outcomes for both the service user and their families (Fischer et al 2008; Dixon, McNarey and Lehman 1995). 0 Management of myeloma should take account of the disease, its complications, and also psychosocial issues affecting the patient and their environment. Nonetheless, they do provide a good grounding for recommending that such interventions show promise for enhancing service user and carer experience. Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels (Cleary et al 2009) and even low levels of substance misuse can have detrimental effects and cause serious complications (Barrowclough et al 2001). All of the above recommendations would enhance service user and care giver experience through staff being more knowledgeable about working with dual diagnosis and providing evidence based psychosocial interventions. That is not saying that drugs are the first thing therapists should try. The robustness of the study was discussed above. psychosocial disability, or early in their NDIS planning, is a possible and desirable focus for the Scheme’s development. ; Buchanan, R.W. Unfortunatly, from experience, this is still not a reality and although such teams are present, there is too much demand for such specialised services. It’s especially important to try to educate family members to support someone who is ill, since negative treatment of an illness by family can have an adverse effect. England: Open University Press Reader, D. (2002) Working with Families. (1996) Compliance therapy in psychotic patients: randomised controlled trial. & Hennen, J.A. In order for mental health professionals to provide interventions such as the ones explored in this report, training will need to be given and adequate support and supervision. Then maybe confidence to work with complex cases may increase, enhancing the service users experience of mental health services and improving individualised outcomes. This therefore suggests each individual has a unique interaction between their own health and social care needs, therefore, requiring personalised responses from mental health services. & Ryrie, I. 6(3), 157-169. He had a very poor relationship with his mother and siblings (although he did reside with them) and never saw his father. & Owen R.R. designed to change emotions by decreasing emotional distress and increasing emotional comfort, as. 14, 4-12 Brooker, C. & Brabban, A. London: National Institute for Health and Clinical Excellence. Various forms of psychosocial intervention have been found efficacious as adjunctive treatments for bipolar disorder, including family-focused therapy, interpersonal and social rhythm therapy, cognitive-behavioral therapy, and individual or group psychoeducation. (eds) (2004) The Art and Science of Mental Health Nursing: A Textbook of Principles and Practice. Elyn's symptoms included talking and [...], Do you ever wonder what is going on in someone's head? British Journal of Psychiatry, 160, 601-620 Kemp R.; Hayward, P.; Applewhaite, G.; Everitt, B. As possible methods of overcoming these a number of recommendations have been made. They go on to suggest that human illness and behaviour are not predicable and neither can be thought of as a simple cause and effect system. American Journal of Psychiatry. Assertive community treatment encompasses an array of services and interventions provided by a community-based, interdisciplinary, mobile treatment team (Stein and Test, 1980). @Soulfox -- Good point, but there are times when a physical condition prevents someone from acting with societal norms. Richmond, I.C. Within this study participants were paid for their expenses and time attending assessments. In addition to this mental health services need to be clear on their admissions criteria, accepting that substance misuse and psychosis are co-morbid and not two separate entities where one must be eradicated before a person can access services. Aliases are used within the scenarios of this report in order to maintain anonymity of the service users and carers described to illustrate points and examples. Influenced by the interplay of human He was re-admitted to the acute ward. People with any form of chronic illness may find support groups locally or on the Internet, and though they differ in quality, a sense of connectedness to others or of being able to share with other people may keep folks more invested in society. This fuelled the voices and they became much more negative. In psychosocial interventions that are designed for groups, another effective tool is utilizing group therapy or other forms of peer support. Generally the research and literature supporting the use of CBT for Those with serious mental illness often excludes people who misuse illicit drugs and/or alcohol for example Garety et al (2008), and Jackson et al (2008). & Foster, J.H. They suggest their findings add evidence to the recommendations made for implementation of interventions for this client group presented in Mental Health Implementation Guide: Dual Diagnosis Good Practice (DOH 2002). (2006) Cognitive Behavioural Therapy for Substance Use Disorders in People with Psychotic Disorders. A place was found for Luke at a rehabilitation unit but he must first give up the use of any illicit substances or he would not be admitted. Tricia has a Literature degree from Sonoma State University and has been a frequent wiseGEEK In addition to this there are service users who do not wish their care givers be informed of their illicit drug use as they are worried of the consequences this may bring, for example: negative appraisal due to the stigma surrounding substance misuse. Unfortunately, family relationships of those with dual diagnosis can often be put under vast amounts of strain that cause the family dynamics to breakdown. What else is considered abnormal now that might be seen as socially acceptable a decade or so from now? ; Moring, J.; O’Brien, R.; Schofield , N. & McGovern, J. 23(4),463- 470 Graham, H.; Copello, A.; Birchwoord, M.; Orford, J.; McGovern, D.; Georgiou, G. & Godfrey, E. (2003) Coexisting severe mental health and substance use problems: developing integrated services in the UK. For example Baker et al (2006) outlines components of CBT sessions used within their trial. His Community Mental Health Team found it difficult to meet all of his complex needs and Luke ended up back on an acute ward. Psychosocial interventions were defined as any intervention that emphasizes psychological, behavioural or social factors rather than biological factors, such as pharmacotherapy. Luke was brought up in a deprived area of a large city and often experimented with illicit substances with his friends. London: Department of Health DOH (2002) Mental Health Policy Implementation Guide: dual diagnosis good practice guide. The difficulty is in balancing the needs of both. Her life became very chaotic and at 16 her mother kicked her out. (2000) Psychosocial Approaches to Dual Diagnosis. 63(3), 202-208 Turner, P. & Mjolne, I. & Wong, W. (2006) Family intervention for schizophrenia. 27, 183-186 Graham, H.; Copello, A.; Birchwood, M. J.; Mueser, K.; Orford, J.; McGovern, D.; Atkinson, E.; Maslin, J.; Preece, M.; Tobin, D. & Georgiou, G. (2004) Cognitive-Behavioural Integrated Treatment (C-BIT): A treatment manual for substance misuse in people with severe mental health problems. In addition, many drug and alcohol workers have only had minimal education in mental health issues (Frankel 1996). Additionally, when people are trained to deliver specific interventions they require ongoing clinical supervision to build on skills and knowledge, improving competence and confidence (Brooker & Brabban 2004). ; Daley, D.C.; Doreau, H.R. British Medical Journal. London: Department of Health DOH (1999b) Drug Misuse and Dependence: Guidelines on Clinical Management. Examples of Psychosocial Interventions. An example of how ‘The Stress Vulnerability Model’ can be illustrated to enable it to be shared with a service user with complex needs, using an easy to understand analogy can be seen in Appendix 1. Although carer outcomes were reported within the Haddock et al (2001) paper they are only briefly examined with more of an emphasis based on cost effectiveness. Weiss, R.D. 42(1), 39-41 Cather, C. (2005) Functional Cognitive Behavioural Therapy: A Brief Individual Treatment for Functional Impairments Resulting From Psychotic Symptoms in Schizophrenia. Negative impacts on – Social relationships Financial resources (of individual and/or family/friends) Family Relationships i.e. (1992) Recent developments in expressed emotion in schizophrenia. Learning Objectives • Be aware of the range of psychosocial interventions. Hopefully, overcoming any negative thoughts and feelings towards those with dual diagnosis. & Yusopoff, L (1993) A Trial of Two Cognitive Behavioural Methods of Treating Drug Resistant Residual Psychotic Symptoms in Schizophrenic Patients. From experience this can be overcome in some cases through normalisation and psycho-education. Its emblem was a red cross on a white background – the reverse of the Swiss flag. Turner & Mjolne (2001) and Khan et al (1999) both suggest Journal clubs are an effective way of promoting wider reading and utilization of research. ; Essock, S.M. 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