Tham, S. & Solomon, P. (2024). Family involvement in routine services for individuals with severe mental illness: Scoping review on barriers and strategies. Psychiatric Services, 75 (10), 1009-1030.
Objective: The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment.
Methods: Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used.
Results: Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers’ negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies.
Conclusions: A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.
Tham, S. & Solomon, P. (2023) Practicing Cultural Humility Will Achieve Recovery-oriented Mental Health Practice and Service Delivery.
The authors have proposed incorporating the concept of cultural humility to achieve better recovery outcomes. While agencies have mandated staff training in cultural competence, health outcomes have not shown promising results. Given the shortcomings of cultural competence training, cultural humility is being suggested as a complementary approach. When providers adopt cultural humility into their interactions with service users, it encompasses underlying principles and values consistent with recovery-oriented practices. Cultural humility addresses power imbalances and emphasizes ongoing self-reflection and openness to interpersonal relationships. The authors believe that embracing cultural humility will promote dignity and respect, create a culture of collaboration and partnership, acknowledge the uniqueness of each individual, enhance person-centered care, and foster self-determination and autonomy. The application of a cultural humility lens can promote a recovery-oriented culture within mental health services, and it is the responsibility of providers to actively cultivate cultural humility. Overall, cultural humility presents new opportunities for practice, and its adoption may be a key factor in promoting a recovery-oriented culture within mental health services.
Solomon, P. & Petros, R. (2021) . What’s the function of outpatient commitment? Administration and Policy in Mental Health and Mental Health Services vol 48, 1- 3.
What is the problem that mandatory community treatment orders are trying to solve? Addressing acute and imminent threats to safety necessitates in-patient commitment; hospital-level of care is required in such scenarios. If a person does not pose an imminent risk of harm to self or others, the underlying concern is promoting long-term recovery and preventing decompensation—both require internal motivation to manage illness and build a life worth living. Community mandated treatment orders are a short-term solution for a long-term goal—a goal that demands a collaborative and supportive approach, engenders empowerment, and encourages a self-directed pursuit of recovery.
Petros, R. & Solomon, P. (2020). Social workers’ propensity to endorse recovery-oriented service provision: A randomized factorial design. British Journal of Social Work, 50, 42-61.
Providers inconsistently provide recovery-oriented services to adults with serious mental illness despite US federal mandate. An online randomized factorial survey was
used to identify and evaluate predictors of social workers’ degree of endorsement of
recovery-oriented service provision. Respondents (N = 107) each rated scale items indicating support for recovery-oriented services for four client vignettes (n = 398) and
completed standardized measures of recovery knowledge and expectations. The final
predictive model was significant, accounting for 61 per cent of the variance
of the degree of endorsement of recovery-oriented services. Recovery knowledge
explains the largest portion of the variance, followed by psychotic symptoms.
The finding that client characteristics predict endorsement of recovery-oriented services
suggests a fundamental misunderstanding of recovery. Recommendations include
training and supervision to enhance application of recovery-oriented principles to service provision.
Kageyama, M. Solomon, P. (2019). Physical violence experienced and witnessed by siblings of persons with Schizophrenia. International Journal of Mental Health, 48(1), 2-13.
Violence by adults with severe mental illness mostly perpetrated against family members, not strangers. The study aimed to clarify rate of violence experienced and/or witnessed by siblings of patients with schizophrenia and factors related to siblings experiencing and/or witnessing violence.
Labrum, T. & Solomon, P. (2017) Rates of victimization of violence committed by relatives with psychiatric disorders. Journal of Interpersonal Violence. 32(9), 2955-2974.
The article presents results of a national online survey of 573 adults with an adult relative with a psychiatric disorder. Nearly half of all respondents reported being a victim of violence committed by their relative and about a quarter reported being a victim in past 6 months. No statistically significant differences were detected in rates of victimization based on relationship type of respondent to their relative.
Petros, R., Solomon, P. (2015) Reviewing Illness Self-Management Programs: A Selection Guide for Consumers, Practitioners, and Administrators. Psychiatric Services, 66 (11), 1180-1193.
Review of the 5 illness self-management programs for persons with severe mental illness in terms of content, strategies, and evidence of effectiveness, including WRAP and IMR.
Solomon, P., Hanrahan, N., Hurford, M., DeCesaris, M., Josey, L. (2014). Lessons learned from implementing a pilot RCT of Transitional Care Model for Individuals with serious mental illness. Archives of Psychiatric Nursing, 28, 250-255.
Adapted an EBP for older adults transition from hospital to adults with severe mental illness delivered by a nurse practitioner. Those with pressing physical health problems were most receptive to service. Psychosocial needs and relationship issues most demanding. A team with a social worker and a peer would enhance this intervention.
Solomon, P., Molinaro, M., Mannion, E., Cantwell, K. (2012). Confidentiality policies and practices in regard to family involvement: Does training make a difference? American Journal of Psychiatric Rehabilitation, 15, 97-115.
Despite evidence that inclusion of family and significant others enhances recovery and other outcomes, misperceptions of confidentiality policies by providers is a barrier to inclusion. Reports on a survey, pilot study, and an evaluation of training of confidentiality policies and regulations.
Solomon, P., Alexander, L., Uhl, S. (2010) The relationship of case managers’ expressed emotion to clients’ outcomes. Social Psychiatry and Psychiatric Epidemiology. 45, 165-173.
Expressed Emotion (EE) has been investigated on a limited basis for non-family members. This study assessed case managers (CM) EE in relation to client outcomes. High EE of CMs was related to negative client attitudes toward adherence to medication, positive number of social contacts and no relationship to quality of life, treatment participation, or satisfaction with case management.
Solomon, P., Cavanaugh, M., Gelles, R. (2005). Family violence among adults with severe mental illness: A neglected area of research. Trauma, Violence, and Abuse, 6, 40-54.
Review of literature finds that families of adults with severe mental illness have a higher rate of violence, but this is a neglected area of research. Proposes a conceptual framework to stimulate research in this domain.
Solomon, P. (2004) Peer support/peer provider services: Underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27, 392-401. Reprinted in Swarbrick, M., Schmidt, L. (2010) . People in recovery as providers of psychiatric rehabilitation. United States Psychiatric Rehabilitation Association, Linthicum, MD.
Defines peer support/peer provided services, underlying psychosocial processes and delineates benefits to peer providers, those receiving services and mental health delivery system. The critical ingredients of peer provided services, critical characteristics of peer providers, and mental health system principles for achieving maximum benefits are discussed.
Solomon, P., Draine, J., Marcus, S. (2002) Predicting Incarceration of Clients of a Psychiatric Probation and Parole Service. Psychiatric Services, 53, 50-56.
Assessed extent to which clinical characteristics, psychiatric status and mental service use explained incarceration for technical violations rather than new offenses for offenders with severe mental illness. Results are mixed. Services that emphasize monitoring increases risk whereas increased participation and motivation to participate reduces risk of incarceration.
Solomon, P., Draine, J., Mannion, E., Meisel, M. (1997). Effectiveness of two models of brief family education: Retaining gains of family members of adults with serious mental illness. American Journal of Orthopsychiatry, 67, 177-186.
Three months post family interventions showed an initial effect for improved self-efficacy for families of an adult relative with a severe mental illness and gains were maintained for a 6-month follow-up. However, no significant differences were found between the treated and untreated group at 6-months. Means to refining interventions are discussed to improve gains overtime.
Solomon, P., Draine, J. (1995). One year outcomes of a randomized trial of case management with seriously mentally ill clients leaving jail. Evaluation Review, 19,256-273.
Hypothesized that those who received services from a team of consumer case mangers versus a team of non-consumer case managers would have the same clinical and social outcomes. No differences in most outcomes except less satisfaction with treatment and less family contact with those served by the consumer case managers.
Solomon, P. (1996). Moving from psychoeducation to family education for families of adults with serious mental illness. Psychiatric Services, 47, 1364-1370. Reprinted in a Compendium on Families & Mental Health Treatment, Psychiatric Services Resource Center.
Family psychoeducation programs offered for many years with the primary goals of reducing the adult relatives relapse and rehospitalization rates. More recently family educational interventions provided to improve family’s quality of life by reducing stress and burden and secondarily to benefit the relative with severe mental illness.
Solomon, P. (1992). The efficacy of case management services for severely mentally disabled clients. Community Mental Health Journal, 28, 163-180.
A review of the effectiveness of case management programs/services for adults with severe mental illness.
