The Clubhouse Model of Psychosocial Rehabilitation provides non-clinical social support for adults living with a diagnosed mental illness or self-reported mental ill-health (referred to as 'members'). The Stepping Stone Clubhouse in Brisbane, Australia was evaluated between August 2022 and August 2023 using a participatory action research approach. Data was sourced from member surveys, member interviews, and an existing Clubhouse Member Database. Outcomes included members' self-reported psychosocial recovery, social connectedness, quality of life, frequency of hospitalizations, and their attainment of employment and/or education aspirations. In this cross-sectional evaluation, it was hypothesized that existing members (membership: 11 months - 28 years) would report better outcomes than new members (membership: 0-14 days). In total, 161 existing members and 76 new members completed a survey. Twenty-three members also participated in a semi-structured interview. Participants were aged on average 47.1 years (± 13.5), 62% were male and 31% had a primary diagnosis of schizophrenia/schizoaffective disorder. Existing members reported better scores than new members for: three of the four psychosocial recovery domains (Functional Recovery: 78.0% vs. 74.0%, p = 0.01; Symptom Management Recovery 69.5% vs. 65.2%, p = 0.03; Social Recovery 74.3% vs. 70.0%, p = 0.01); social connection with other members (38.1 vs. 32.2, p = 0.03) and staff (44.5 vs. 38.1, p = 0.02); quality-of-life summary scores (4.6 vs. 4.1, p = 0.01), and rates of mental health-related hospitalization (16% vs. 41%, p < 0.01). Existing members were also more likely to be in some form of employment, compared to new members (p = 0.01). There were no significant differences between existing and new members for their educational goals, with 58% of each group wanting further formal education. Stepping Stone members have better outcomes than members who have recently joined the Clubhouse. This evaluation was successful because it intentionally built evaluative capacity and empowered member-centric processes.

A major component of recovery is the inclusion of lived experience to transform the culture of Mental Health (MH) services. In Israel lived experience has been increasingly integrated into services through peer roles. However, lived experience knowledge and expertise has not been sufficiently nor systematically integrated into the design of mental health research. This paper documents an attempt to initiate change by convening multiple stakeholders (with and without lived experience) in a specialized workshop aiming to learn and discuss the potential role of lived experience for mental health research in Israel. Participants raised ideas and core questions on how lived experience can shape research and augment mental health practices and policies. They highlighted current challenges regarding self-disclosure facing lived experience researchers, as well as challenges for developing participatory research collaborations among consumers, family members and practitioners. By bringing to the fore-front the 'insider perspective' of MH system as experienced among service users and families, we expect a development of a research culture with reduced paternalism, increased coproduction and recovery-orientation. We hope this endeavor will inspire others and help develop a lived experience expertise-based research network of interested stakeholders.

Autism is a rapidly growing phenomenon, with rates of diagnosed autism in the community rising every decade. Autism and traits of autism are also regularly part of presentation at youth mental health services, including early psychosis services. In early psychosis services young people's symptoms tend to be formulated through a psychosis lens, rather than a neurodevelopmental lens which can lead to unnecessary medicalised treatment, and treatment plans that do not consider the possible impact of neurodiversity. The following paper explores autism and traits of autism in relation to youth early psychosis, examining the complexity in accurate formulation, and the possible impacts for young people. Future directions for how services can address this issue and more effectively tailor treatment to young people are also discussed.

To mitigate barriers to care among youth (12-25 years), community-based organizations have increasingly integrated peer support as a complement to clinical mental health care; however, information regarding the integration process is lacking. To explore organizational perspectives regarding the contexts and mechanisms underlying integration of peer support for youth accessing mental health services from community-based, youth-serving organizations. Representatives from community-based youth-serving organizations completed a survey describing the contexts in which they are located and their experiences integrating peer support. Text responses were analyzed using directed content analysis. 21 organizations serving youth aged 11-29 years responded. Three generic categories were identified: 1) Context is key and safe environments, 2) Supportive organizations and valuing lived experience, 3) Benefits for peer support providers and receivers and purposeful integration into the organization. Peer support integration requires valuing of the lived experience of peers and creation of a safe organizational environment.

Despite the international incentives and the worldwide development of recovery-oriented policies, it has proven challenging to establish recovery-oriented mental health services that take into account users' subjectivity and perspectives (Slade et al., World Psychiatry 13(1):12-20, 2014. https://doi.org/10.1002/wps.20084 ). The objective of this study was to identify individual beliefs that are correlated with six recovery-oriented practices in schizophrenia among mental health professionals. Seven individual beliefs were examined for their association with each of the aforementioned practices: belief in recovery possibilities, biological beliefs, desire for social distance, perceived similarities, professional utility beliefs, continuum beliefs, and categorical beliefs. The results indicated that belief in the possibility of recovery from schizophrenia and professional efficacy beliefs were the most strongly associated with the six recovery-oriented practices examined. Conversely, there was a negative association between stigma score (desire for social distance) and the six recovery-oriented practices. The remaining four beliefs-biological, perceived similarity, categorical, and continuum-were found to be more weakly associated with recovery-oriented practices. In light of these findings, it is evident that mental health professionals' individual beliefs warrant further consideration in research endeavors aimed at fostering and facilitating the implementation of recovery-oriented practices.

This pilot study evaluated the feasibility of the technology specialist intervention, which assists clients in achieving mental health recovery and well-being goals via existing digital tools in a real-world community mental health setting. Thirteen adult clients with serious mental illness and their providers completed baseline, 3-, and 6-month assessments, including goal setting, self-efficacy, activation, and acceptability measures, along with weekly ecological momentary assessments. Clients selected goals and corresponding tools, used the tools steadily, and showed improvement in activation and self-efficacy. Most participating clients (82%, n = 9) and providers (80%, n = 8) found the intervention acceptable. These preliminary findings show that the technology specialist intervention is promising and warrants further testing.

Many suicidal individuals do not access outpatient treatment, and those who do often do not receive empirically supported treatments for reducing suicide risk. Few studies have investigated the barriers to and facilitators of outpatient mental health (MH) treatment among suicidal individuals. We used a survey to understand the experiences of those with a history of suicidal ideation. Participants (N = 111) with a history of suicidal ideation during adulthood answered questions about their history of suicidal thoughts and behaviors (STBs), MH treatment, and their perceptions of barriers to and facilitators of treatment. We found that participants who reported a lifetime suicide attempt endorsed greater barriers to (t(106) = 2.76, p = .003) and weaker facilitators of (t(109) = -1.8, p = .037) receiving outpatient treatment for STBs; additionally, attitudinal barriers were associated with having made a suicide attempt (OR = 3.47, 95% CI [1.18, 10.20], p = .024). These results emphasize the importance of efforts to bolster facilitators and mitigate barriers to treatment for STBs. Future work should continue to elucidate treatment barriers and facilitators to improve treatment engagement for suicidal individuals.

Pharmacists are highly accessible healthcare professionals with presence in communities, hospitals, and clinics. They are well positioned to expand their roles in supporting individuals with mental health challenges. A cross-sectional study was conducted to identify trends in how pharmacists assess, monitor, identify, and care for patients with mental health challenges. The survey was distributed to licensed pharmacists in Washington State (n = 8,082) in 2023. Questions addressed the provision of mental health supports and services provided by pharmacists, respondents' self-assessed preparedness in delivering services, and professional and personal demographics. Data were analyzed using descriptive statistics and logistic regression. A total of 856 responses were received (10.6%) and 810 were included in the final dataset. Most respondents held a PharmD degree (74%). Common practice environments included community (37%), hospital (27%), and clinic (21%) settings. Less than 1% were board-certified psychiatric pharmacists. The most common mental health services provided involved medication-related services, including talking to patients regarding psychiatric medication (51%), consulting with physicians (47%), and assessing side effects (45%). Over 60% of pharmacists reported being prepared to deliver these services. Less than 30% of pharmacists indicated they were prepared to conduct mental health screenings or make referrals, and provision of these services was low. A statistically significant association was found between preparedness and providing supports and services (p < 0.001). Overall, pharmacists indicated they were more prepared and frequently delivered services related to medication use for mental health indications, while preparedness and offerings for non-medication activities was low, highlighting opportunities for further professional development.

Using the Cascade of Care framework, we explored the demographic and clinical characteristics of students at six stages in an early psychosis detection program at a college counseling center, with a focus on the transition between stages with the highest disengagement. We detailed and compared the demographic and clinical characteristics of those who (1) completed the Prodromal Questionnaire-Brief (PQ-B, N = 1588); (2) met the PQ-B cutoff score (n = 486); (3) were referred for secondary phone screening (n = 404); (4) completed secondary phone screening (n = 198); (5) completed a Coordinated Specialty Care (CSC) eligibility assessment (n = 51); and (6) were enrolled in CSC (n = 21). Education level and gender identity were associated with engagement at multiple stages of the early detection cascade. Graduate education level, transgender or gender diverse gender identity, alcohol use, and depressive symptoms predicted student follow-through with referral to secondary phone screenings.

Clinical leverages and pressures are often utilized in psychiatric treatment settings. Clinicians know they are controversial but think of them as useful and relatively harmless. Perception of coercion is known to be deleterious to therapeutic relationship and clinical outcomes. We assessed individuals (N = 137) receiving care in outpatient and community psychiatric settings in a Canadian urban center regarding their current experiences of clinical leverage (in finance, housing, access to/custody of children, and family), and perception of coercion. Analyses show clinical leverage are common (34.8% overall), with access to child and family (15.7%), and financial (14.6%) leverages being most common. Generalised linear models indicated that psychiatric symptomology (p < 0.001) and current financial leverage (p = 0.035) were positively associated with perceptions of coercion. The results highlight that clinical leverages are widespread, associated with perception of coercion, and are likely harmful with negative impact on patient care and outcomes. Efforts to mitigate these impacts are needed.

The U.S. mental health crisis requires new tools to address mental healthcare needs. Data dashboards are a means of sharing community health data on many topics, including mental health. Unfortunately, many "community" dashboards are designed without stakeholder input. This article outlines the creation of the State of Texas Mental Health Dashboard and how researchers incorporated stakeholder feedback throughout its development. Researchers conducted nine focus groups with community stakeholders from two Texas counties. This feedback illustrated some key differences between designers' priorities and what stakeholders considered most relevant. Designers prioritized access to state and local mental health data. While stakeholders found the data useful, they also advocated for tools to identify community mental health resources. Our findings illustrate how excluding stakeholder voices from the design process could have omitted a key element needed to address mental healthcare needs and provides a process for ensuring that local input drives the design process.

The current study assessed associations between negative experiences with police and self-directed violence (SDV) among a United States (US) sample of Black young adults ages 18-29 reporting lifetime police stops. Data come from the "INtervening on Self-Harm and Policing to Increase Racial Equity" (INSPIRE) survey (N = 672) and were collected between December 2023 and March 2024. This high-risk sample exhibited elevated rates of self-harm ideation or NSSI (27.23%) and attempted suicide (48.22%). Findings also revealed that, net of covariates, both police discrimination and arrest increased the relative risk of self-harm or NSSI by 257% and 242%, respectively. These police experiences also significantly increased the risk of attempted suicide. When examining specific forms of police discrimination, discrimination by race, immigration status, and sexual orientation emerged as significant predictors of one or more SDV outcomes. Results signal a need for SDV screenings among Black young adults with a history of negative experiences with police discrimination and arrest in the US.

Funding for suicide postvention services, which provide support after a suicide death, has increased in Australia and globally. This rise accompanies a need to demonstrate outcomes of support. However, articulating and quantifying these outcomes presents ethical and logistical challenges. Funders' priorities may differ from those of service users. To discern the value and explore effective measurement of postvention outcomes, focus groups were conducted with postvention staff and lived experience representatives from an Australian postvention service. Transcripts were analysed using Braun and Clarke's Reflexive Thematic Analysis. Results highlighted the complex context of measuring outcomes in suicide postvention and emphasized the need for flexible approaches to service provision and outcome measurement. The study suggests that the most significant benefits, as perceived by participants, are the 'flow-on' effects of postvention. It supports the notion that outcome measures require careful consideration, with trade-offs evaluated to understand what is truly valuable in suicide postvention services.

Engagement with traditional mental health services can be particularly challenging for young people experiencing severe and complex mental health problems. Assertive community treatment-based services providing mobile outreach, such as Intensive Mobile Youth Outreach Services (IMYOS), operate across Australia to support these young people's mental health needs in the transition to adulthood. Past research on IMYOS has focused on quantitative outcome measures, and young people's experiences of this type of model are poorly understood. This study explored youth service users' experiences of an IMYOS program, focusing on the model and intervention aspects perceived as barriers and facilitators to their overall recovery and service engagement. Semi-structured, in-depth interviewing was undertaken with nine young people aged 16-19 years (M = 17.61 years) who were current or recent service users of an IMYOS program in Melbourne, Australia. Data were analysed using thematic analysis. Having a therapeutic space, clinicians' specialised expertise, use of an outreach and community-oriented approach, and care continuity and availability across settings were program aspects identified by young people as facilitating their recovery and service engagement. Program aspects perceived as barriers to recovery and engagement were clinical unsuitability and ineffectiveness of the program and interventions, and conflicts between personal autonomy and assertive care. Young people's perceptions of clinical suitability and therapeutic relevance influenced their evaluations of the overall effectiveness of the IMYOS service, which subsequently impacted their engagement. The findings provide opportunities for IMYOS clinicians to enhance young people's recovery and engagement outcomes and have implications for the improvement of this innovative service for at-risk young people.

The Clubhouse model of psychosocial rehabilitation has supported the recovery of people with serious mental illness for over 75 years, but many of the roughly 350 Clubhouses are not well-integrated into the larger health care system, limiting their reach. This article examines Clubhouses' and psychiatric providers' interactions and experiences to understand the nature of and barriers to partnerships. The directors of Clubhouses affiliated with Clubhouse International were surveyed, examining their attitudes and practices around collaboration with psychiatric providers. To provide context, psychiatric providers were also surveyed regarding their understanding of and experiences with Clubhouses. Findings reveal broad support among both Clubhouse directors and psychiatrists for enhancing partnerships, despite current barriers, limited interactions, and the need for greater mutual understanding. Key considerations that emerged include the importance of maintaining the Clubhouse model's distinct non-clinical, community-based, and member-directed identity in any integration efforts.

Understanding the current state of equity, diversity, and inclusion (EDI) within the crisis line sector is essential to enhancing accessibility and acceptability of crisis line services for all. Through an intersectional lens, we examined 9-8-8 crisis line workers' personal and work demographics, training, resources, perceived competencies in supporting diverse populations. We conducted an electronic survey of crisis line responders and leadership in Canada. Data was analyzed using descriptive statistics, Fisher's test, and Mann-Whitney U/Kruskal-Wallis H tests. Open ended responses were analyzed using content analysis. 323 surveys were completed. Analysis revealed statistically significant associations between respondent demographics, training satisfaction, access to resources, and perceived competency in supporting diverse communities. Conclusion: The findings indicate the need for new approaches to recruitment and training in the crisis line sector to enhance the inclusivity of crisis services for all individuals seeking mental health support.

Various behavioral health crisis models have been developed to advance the shared goals of improving behavioral health outcomes and increasing diversion from criminal legal systems. The effectiveness of these models is promising, yet research is needed to understand their comparative advantages. This study compares the effectiveness of three community mental health response models-co-response, mobile response, and office-based response-and law enforcement-only response in addressing key behavioral health and diversion goals. These goals include improvements to follow-ups, service linkages to community resources, crisis de-escalation, and dispositions (i.e., decreasing hospitalizations and arrests). Five partner sites in Michigan provided administrative data on crisis cases and outcomes. The sample included crisis cases from one office-based model (n = 91), two mobile response models (n = 306), and two co-response models (n = 322), along with data from the partnering law enforcement agencies at each site (n = 669). Results show that model type is associated with all key outcomes. Mobile response effectively met all examined crisis response goals, including by resolving crises informally or without hospitalization, providing links to community services, and conducting follow-ups. Co-response showed some success in meeting goals, while the law enforcement-only model showed more limited results. Additionally, law enforcement presence during a mobile crisis response produced worse disposition outcomes, while contacting a CMH during law enforcement response produced better disposition outcomes. Overall, this study contributes to SAMHSA's (2020) crisis response vision to effectively meet the behavioral health needs of those in need of service by providing "someone to respond."

As mental health needs rise, creative and timely solutions are essential. Leveraging the expansion and flexibility of virtual services to create telehealth and hybrid offerings is crucial for addressing systemic barriers in mental health, enhancing accessibility, and providing flexible, comprehensive care options for diverse patient populations. This article discusses the development of a mental health urgent care program within a large medical system in a densely populated, under-resourced community. The program was designed to address common community mental health barriers across multiple care entry points, including ambulatory settings, emergency care, and consultation services. Using a multipronged approach, this program aims to improve patient access, care continuity, and outcomes. The authors encourage others to consider adopting a similar programmatic infrastructure to reduce mental health care barriers in their communities.

Young adults with early psychosis often disengage from essential early intervention services (i.e., Coordinated Specialty Care or CSC in the United States). While decision support interventions improve service engagement, their use in this population is underexplored. This study evaluated the feasibility, acceptability, fidelity, and potential impact of a decision coaching intervention for young adults with early psychosis in CSC services. Using a mixed-method, longitudinal, collective case study design, we assessed the intervention's impact on decision-making needs through the Decisional Conflict Scale and qualitative interviews. We also evaluated feasibility, fidelity, and acceptability through observations and feedback from interventionists and participants. Eight young adults from three CSC programs participated, showing variable engagement, with generally favorable fidelity and acceptability ratings. The Decisional Conflict Scale revealed mixed findings, while four themes from qualitative interviews emerged: Perspective and Information Seeking, Motivation and Prioritization, Empowerment and Confidence, and Critical Thinking and Evaluation. The findings suggest that training CSC providers-including peer specialists and clinicians-to deliver decision coaching with fidelity is feasible, well-received by young adults, and potentially impactful on decision-making. Replication in a larger controlled trial, addressing observed study limitations, is warranted. This trial was registered with ClinicalTrials.gov (Identifier: NCT04532034) on August 28, 2020, as Temple University Protocol Record 261047, Facilitating Engagement in Evidence-Based Treatment for Early Psychosis (https://clinicaltrials.gov/ct2/show/NCT04532034?term=NCT04532034&draw=2&rank=1).

Black Americans with Posttraumatic Stress Disorder have less access to mental healthcare compared to White Americans. Many factors contribute to this inequity, including broader disparities within the healthcare system driven by systemic racism, and an underutilization of mental health services by Black Americans due to provider bias and stigma around mental health care. These disparities are rooted in a racist historical context of exclusion and abuse of the Black community by the White psychiatric establishment, and a perpetration of further trauma on Black clients, a context that is largely missing from traditional mental health education and literature on Black mental health today. This article aims to provide a necessary historical context of how the U.S. mental health care system has excluded Black Americans from trauma treatment. We use a contemporary trauma lens to demonstrate the ways in which Black trauma has existed throughout U.S. history, but how White psychiatry has cast trauma symptoms as evidence of racial inferiority, has excluded Black individuals from treatment, and has abused Black patients, thereby increasing Black trauma. The purpose of this review is to inform and educate mental health providers about our collective history, to counter a narrative of amnesia which identifies Black underutilization of services but forgets the exclusion from and abuse of Black people within the mental health system. We conclude with recommendations that providers can utilize to engage in antiracist practice and create an affirmative space for Black Americans to utilize trauma treatment and mental health care freely.