Health expectations : an international journal of public participation in health care and health policySharon Lawn, Tessa-May Zirnsak, T J Spencer, Elaine Waddell, Jane Fischer, Tarmia Klass, Puneet Sansanwal, Edwina T Light, Vrinda Edan, Chris Maylea, Penelope …
BACKGROUND: Community Treatment Orders (CTOs) are contested practices in mental healthcare due to unresolved evidence of effectiveness and persistent human rights concerns. Despite this, Australia has high rates of CTO use internationally. Research from a lived and living experience (LLE) perspective remains limited. METHODS: This mixed methods research explored experiences of people with LLE of mental ill-health and being on a CTO ('consumers'). An online survey including Likert-rated, categorical and open-ended questions was disseminated across Australia in 2024 to consumers aged 18 years or over. Quantitative data were reported descriptively, and qualitative data were analysed using Latent Content Analysis. RESULTS: Forty-three people completed the survey; most identified as female (86%); 51.2% were aged 30-49 years; 7.2% were currently on a CTO; 40.5% had been on a CTO in the past 1-5 years; and 45.2% had been on a CTO more than once. Automated data contamination ('bot') infiltration hampered inclusion of further data. Participant responses included: (1) experiences prior to being on a CTO; (2) experiences whilst on a CTO; (3) attitudes towards CTOs; (4) family involvement; and (5) views on mental health services. While some consumers reported experiencing positive care, many rejected use of CTOs, reporting coercion, exclusion from decision-making and information, lack of alternative support options, and lack of compassion. CONCLUSIONS: Policy and practice reforms, including focus on recovery and human rights, appear to have failed to improve experiences of CTOs. Further work to close the policy-practice gap and translate policy into more inclusive, human rights-based care is indicated. LIVED EXPERIENCE OR PUBLIC CONTRIBUTIONS: This project has included considerable involvement and community engagement with people with lived and living experience ('LLE') of CTOs and/or mental health service use in all phases of the project. The project includes two Chief Investigators who identify as LLE leaders and researchers (VE and SL), and who have direct lived experience of CTOs, or as a family/caregiver of individuals who have direct lived experience of CTOs. The project manager (TZ) and some project staff (TS, TK, and PS) are LLE researchers, and the project is guided by a Lived Experience Advisory Panel (LEAP) with LLE experience of CTOs, including both service users and family/caregivers. We also have LLE experts on our project's international advisory panel. Together, their contributions have been vital in the project team's open and transparent reflections on their diverse perspectives and positioning which have grounded the project's focus on LLE perspectives.
International journal of mental health nursingSuyoun Ahn, Eunmi Hwang
As community mental health services expand in scope and responsibility, mental health nurses are playing a central role in delivering integrated, recovery-oriented care. However, they face substantial challenges in adapting to community practice and sustaining professional development. Clinical supervision can mitigate these demands through its formative, normative, restorative functions. This study explored the supervision experiences of community mental health nurse specialists in South Korea to provide evidence for specifying the effective functions and operational systems of supervision using an exploratory qualitative design. Twelve community mental health nurse specialists participated in three focus group interviews conducted between June 2024 and July 2025. Data were analysed using reflexive thematic analysis. Four themes and 10 subthemes were generated: translating community mental health ideals into professional practice; serving as an anchor in unfamiliar terrain; supervision undermined by superficiality and disrespect; and competency development constrained by structural barriers. Supervision was perceived as a critical space for clarifying clinical direction, regulating emotional involvement and supporting professional adaptation. However, formalistic delivery and structural constraints limited its impact. These findings highlight the need for integrated and systematic supervision approaches aligned with the community mental health paradigm, supported by organisational and policy commitments to protected time, staffing, education and financial resources. Strengthening supervision under such conditions may enhance practitioner development and service user outcomes.
BMC health services researchJo Day, Julia Frost, Alex Stirzaker, Debra Richards, John Gibson, Vanessa Pinfold, Richard Byng
INTRODUCTION: PARTNERS is a model of care that was co-designed with service users and carers to address the needs of people with severe mental illness to receive better support in primary care. Taking learning from a randomised controlled trial and process evaluation of this complex person-centred goal and coaching-based approach to care, our aim was to understand better the challenges of implementing PARTNERS in complex dynamic service delivery systems. METHODS: We identified two Integrated Care Systems that were interested in adopting the PARTNERS model of care. We trained practitioners to adopt PARTNERS to their local settings and provided meta-supervision (supervision of supervisors). We examined the implementation period that covered site engagement, training of staff and initial delivery of the new PARTNERS model of care, undertaking a qualitative realist evaluation informed by the Consolidated Framework for Implementation Research (CFIR). Data collection involved semi-structured interviews with 10 System Change Leads, Supervisors, and trained intervention practitioners or 'Care Partners'; augmented by observations of supervision and practice within the systems and collation of documents. Analysis was qualitative informed by a realist approach and the CFIR. RESULTS: Analysis identified complex overlapping configurations of teams and roles within them, leadership, and individual characteristics influenced the systems' ability to implement the PARTNERS model of care. The presence or absence of leadership was instrumental in providing clarity regarding where the delivery of PARTNERS sat within newly emerging systems and was an important indicator of successful implementation. Collaborative leadership and supervision, alongside training tailored to the needs of individual practitioners, increased or decreased perceived self-efficacy amongst individual practitioners and their confidence in delivering the PARTNERS model of care. CONCLUSIONS: We identified that both internal and external supervision and system leadership are crucial to the implementation of PARTNERS, backed up by training delivered by a clinician and people with lived experience, to ensure that this new model of care is embedded in everyday practice. It is likely that the absence of any one of these mechanisms could make implementation and sustainability of the PARTNERS model challenging. CLINICAL TRIAL NUMBER: Not applicable.
Early intervention in psychiatryJoséphine Caubel, Donia Bouchiba, Diane Fabre, Albane Mansoux, IJbrand Visser, Laurent Lecardeur
AIM: To develop and describe the implementation and early outcomes of a stepped, transdiagnostic early intervention service (FIPP) for individuals aged 17-30, and to evaluate changes in access, age profile, length of stay, diagnostic mix and community engagement between 2016 and 2024. METHODS: The Jean Wier outpatient centre is part of the public mental health hospital Érasme, which is part of the GHT PsySudParis group in the metropolis of greater Paris (France). Data and surveys showed a treatment gap in service delivery for young people with emerging psychiatric disorders. A comprehensive reorganisation of mental health services was initiated. Developmental aims were training professionals, service establishment and introducing standardised assessment. Evaluation aims were shifts in access, length of stay and diagnostic distribution. RESULTS: The results show an improved healthcare provision by better trained teams, increased community engagement, a diminished average age of service users, a decreased average length of stay and a diagnostic shift in the day-care program (CARE). Duration of untreated psychosis and disengagement have not yet been objectified. CONCLUSIONS: A proactive, structured and collaborative approach in public mental health care can enhance access to early psychiatric care for young adults in France.
Early intervention in psychiatryKevin E K Chai, Elvis Rapoo, Crystal M Y Lee, Peter M McEvoy, Kyran Graham-Schmidt, Daniel Rock, Kim S Betts, Suzanne Robinson, Mathew Coleman
INTRODUCTION: Psychosis is a debilitating condition and prompt treatment is a key prognostic factor. Early intervention services aim to provide timely care, but co-occurring substance use disorders (SUDs) complicate treatment, leading to poorer outcomes. This study examined the clinical journey of individuals with SUD who were subsequently diagnosed with a psychotic disorder, focusing on the interval between diagnoses to understand this issue. METHODS: Patient pathways were constructed using linked health data (2005-2022) from Western Australia for individuals aged ≥ 18 years with a diagnosis of SUD followed by a primary psychotic disorder. Service events across emergency departments (EDs), inpatient and community mental health services were analysed. Descriptive statistics and subgroup analyses examined variations based on the time between diagnoses, sex, remoteness and socioeconomic status. RESULTS: Analysis of 7568 patient pathways revealed a median diagnostic interval of 1.9 years. Initial SUD diagnoses occurred most frequently in inpatient settings (62%), whilst psychoses diagnoses were most common in EDs (46%). Common diagnostic pathways included inpatient to ED (28%) and inpatient to inpatient (24%). Subgroup analyses showed women had a 7-month longer diagnostic interval and six more mental health service events than men. Remoteness and socioeconomic disadvantage correlated with increased diagnosis in inpatient settings and decreased diagnosis in EDs. CONCLUSION: A significant delay between diagnoses is likely associated with poorer outcomes. Integrated service delivery, particularly between EDs and specialised mental health services, is important for early intervention. Patient demographics and geographic location influence diagnostic pathways, suggesting targeted interventions to improve access to prompt, appropriate care.
Information needs among people with dementia and their family carers remain often unmet, despite policy emphasis on information as the key enabler of choice, agency, and empowerment. An intervention to address these unmet information needs was co-designed and implemented in the North-East of England. This study is a realist process evaluation of the intervention's implementation through the local community mental health services for older people. The realist process evaluation drew on three strands of qualitative data: longitudinal interviews with the service manager of the implementing services, longitudinal group interviews with practitioners, and a focus group with the co-design working group. Thematic analysis used a deductive approach to identify implementation outcomes (Reach, Dose, Fidelity & Adaptation, Acceptability, Adoption, Appropriateness, Penetration, Feasibility, Sustainability), followed by a retroductive approach to interpret data through the realist framework of Context, Mechanisms, and Outcomes. Participants showed different strategies for offering the leaflet in clinical practice (Reach), but all appeared to offer it multiple times and at every opportunity (Dose). Some adaptation in implementation was identified. The intervention was successfully integrated into practice (Penetration, Feasibility) and well received by implementers (Acceptability, Adoption). The intervention was perceived as addressing a genuine need and as compatible with the implementation setting (Appropriateness), also in the longer term (Sustainability). Nine levels of contextual factors and eight mechanisms appeared to contribute to the observed outcomes. The study offers an in-depth understanding of how information-giving occurs at the level of the individual practitioner and identifies some variation in information-giving practice. Some participants' approach to information-giving was consistent with a person-centred, relational, and situated approach to care, while others embodied a rational approach to information which did not account for the circumstances of the information recipient. Policy and practice should acknowledge and address this variation to ensure that critical stances on information-giving are widely adopted.
Global health actionRosco Kasujja, Ronald Asiimwe, Barbra Makumbi, Cosmas Goodluck, Mariam Umugwaneza, Ibrahim Luberenga
Lay mental health workers play a central role in implementing and sustaining mental health interventions across East Africa. However, limited research exists on how these workers are trained and supervised, an important gap given their role in addressing the region's severe treatment shortage, where up to 85% of individuals with mental disorders receive little or no evidence-based care. Task-sharing, which involves training non-specialist workers to deliver psychological interventions under supervision, has become a key strategy over the past two decades. Yet, the processes that ensure LMHW competence, fidelity, and wellbeing, particularly training and supervision, remain underexplored. Guided by Arksey and O'Malley's five-stage framework, this scoping review maps and synthesizes literature on training and supervision practices for LMHWs delivering community-based mental health interventions in East Africa. Systematic searches of five databases (Web of Science, Embase, Scopus, PubMed, and ProQuest) yielded records that, after screening and eligibility assessment, resulted in 18 included studies from five of the seven East African countries. Data were charted and thematically analyzed to describe training methods, supervision strategies, outcomes, and implementation challenges. Findings revealed wide variations in training duration and pedagogy, from brief workshops to multi-module or apprenticeship models, and diverse supervision formats, including hierarchical, peer, hybrid, and digital approaches. Evidence showed improvements in client outcomes, provider competence, and service delivery, but highlighted persistent gaps in standardized supervision, sustainability, and workforce support. This review informs policy and implementation efforts to strengthen LMHW training and supervision systems, contributing to narrowing the mental health treatment gap in East Africa.
Frontiers in public healthJosephina Lin, Piper Derenoncourt, Rainelle Walker-White, Nancy Oriol, Daniel Palazuelos, Giuseppe Raviola, Stephanie L Smith, Mollie Williams
Mental health inequities persist in underserved communities due to systemic barriers to care. Healthy Roads, a mental wellness support program developed by the mobile clinic The Family Van, adapted the World Health Organization's Problem Management Plus (PM+) curriculum to address these disparities with support from Partners In Health. PM+ is a brief, evidence-based psychological intervention designed for trained non-specialists to deliver in low-resource settings. This community case study describes the adaptation, implementation, and early lessons learned from delivering PM+ with trained community health workers (CHWs) among racially and linguistically diverse communities in Boston, Massachusetts. Data were collected from 49 participants who engaged in 173 sessions between January 2021 and December 2023. Quantitative outcomes were measured using the Psychological Outcomes Profiles (PSYCHLOPS) tool, alongside qualitative insights from session notes and client feedback. Participants who completed the program experienced a 25.4% reduction in mental health distress 95% CI [13.1, 37.9%], with those attending at least one session experiencing an 11.4% reduction 95% CI [5.8, 17.0%]. This program also demonstrates how community-based mental health initiatives can contribute to broader systems of collaborative learning where frontline providers, participants, community members, and institutional partners jointly adapt and refine program delivery to inform equitable adaptation and dissemination of mental health practices. As the first adaptation of PM + in a community-based mobile clinic in the United States, Healthy Roads offers implementation insights for community health programs on building a mental health workforce reflective of the community, centering community expertise, adapting program delivery for cultural relevance, and ensuring proper staffing to sustain quality care.