Community Mental Health Journal[JOURNAL]
Sun
200 papers
Peer Support Supervision Competencies: Results of Participatory Action Research.
Edwards JP, Spagnolo AB, Cronise R … +3 more , Enders G, Forbes J, Pratt C
Community Ment Health J · 2026 Apr · PMID 41989706 · Publisher ↗
Peer Support Specialists (PSS) are a rapidly expanding workforce in behavioral healthcare, with over 100,000 practitioners currently active in the U.S. Despite the evidence-base for peer services, supervision remains a s...
Peer Support Specialists (PSS) are a rapidly expanding workforce in behavioral healthcare, with over 100,000 practitioners currently active in the U.S. Despite the evidence-base for peer services, supervision remains a significant challenge, often leading to role confusion when managed by non-peer supervisors. This study sought to identify specific supervision competencies that account for unique considerations of PSS. This study utilized a multi-phase Participatory Action Research (PAR) approach, employing online Delphi focus groups and a nationwide pilot survey to identify and validate specific competencies for PSS supervision. Assessing the importance, criticality, and frequency of 71 supervisory tasks across five functions of supervision (Administrate, Support, Educate, Advocate, and Evaluate), identified by 100 PSS and supervisors, yielded the 25 supervisory competencies rated highest and lowest, aligned with the Five Critical Functions of Supervision model. Survey results revealed a high prioritization for tasks that support role clarity, active listening, and leading through empathy. These findings provide an empirical schema for developing standardized training curricula and practice guidelines for ensuring effective and efficient PSS supervision. Results suggest that further research on the competencies of the Five Critical Functions of Supervision model is warranted.
Bridging Systems of Care: Experiences of Faith Leaders Supporting Community Mental Health in Worcester, Massachusetts.
Denoncourt J, Parthiban K, Mullin D
Community Ment Health J · 2026 Apr · PMID 41965485 · Publisher ↗
Amid ongoing workforce shortages in primary and mental healthcare, faith leaders play an important role in supporting individuals with mental health concerns, particularly in culturally diverse urban settings. We conduct...
Amid ongoing workforce shortages in primary and mental healthcare, faith leaders play an important role in supporting individuals with mental health concerns, particularly in culturally diverse urban settings. We conducted semi-structured interviews with 13 faith leaders from diverse religious backgrounds in Worcester, Massachusetts. Interviews explored understandings of mental health, approaches to supporting congregants, and interactions with the healthcare system. Data was analyzed using thematic analysis. Four major themes emerged: (1) faith leaders are approached for a breadth of mental health concerns which are understood to be multifactorial; (2) faith leaders are accessible and complementary resources; (3) faith leaders are vulnerable to burnout; and (4) collaboration with the health system is limited and inconsistent. Ultimately, we describe that faith leaders offer accessible, comprehensive, longitudinal, and coordinated mental health support, though encounter significant challenges including outdated referral resources, lack of formal training, emotional burden, and inconsistent engagement from healthcare systems. Strengthening collaboration through faith leader training programs, updated referral pathways, shared dialogue spaces, and improved cultural and religious competency among clinicians has the potential to improve community mental health by targeting specific, modifiable barriers identified by faith leaders.
Integrated Care Within New Zealand's Specialist Mental Health and Addiction Services: Qualitative Research to Inform a New Model.
King H, Derrett S, Wyeth EH … +2 more , Cunningham R, Peterson D
Community Ment Health J · 2026 Apr · PMID 41961214 · Publisher ↗
Internationally, and within New Zealand (NZ), specialist mental health and addiction service-users (SMHAS-users) experience increased risks of comorbidities and premature mortality, and poorer health outcomes, compared t...
Internationally, and within New Zealand (NZ), specialist mental health and addiction service-users (SMHAS-users) experience increased risks of comorbidities and premature mortality, and poorer health outcomes, compared to the general population. In particular, Indigenous Māori SMHAS-users face significant inequities compared to non-Māori. Integrated care has been found to improve outcomes by improving quality and coordination between services. This research aimed to develop a model of integrated care relevant to SMHAS-users in a NZ context, to inform the development of a questionnaire intended to assess SMHAS-users experiences of integrated care, support SMHAS to improve their services, and in turn, improve outcomes for SMHAS-users. Key informants working for, and/or with lived experience of, SMHAS were interviewed about existing integrated and people-centred care concepts. Barriers to integration were identified. The team met frequently to review and discuss coding, themes, and model development. Ten informants from across NZ were recruited, including five with lived experience of mental distress, and three who were Māori. Singer et al.,’s (Medical Care Research and Review, 68(1), 112–127, 2011) integrated patient care framework and the World Health Organization’s (2016) concept of people-centred care were found to be acceptable, although people-centred constructs were needed more clearly at a model’s core. SMHAS-user controlled funding and participation in multi-disciplinary team meetings were identified as key opportunities alongside other concepts such as cultural responsiveness, de-centralising services (to re-centralise people), and peer navigators. The resulting People-Centred Joined Up Care (PCJUC) model is proposed to convey a paradigm shift from a service-centric system, organised around the efficiencies and needs of services, to a people-centred system. Irrespective of the health workforce’s best intentions, the current service-centric orientation does not empower SMHAS-users. A people-centred model requires power structures to be inverted and the paramount authority of health professionals as the ‘decision-making experts’ to be challenged. Research is now underway exploring the use of a questionnaire developed to measure the concepts within the PCJUC model, to inform service improvements.
Patient and System Factors Associated with Second-generation Antipsychotic Metabolic Lab Monitoring, a Retrospective Cohort Study.
Singhal S, Mikulich-Gilbertson SK, Garcia ME … +2 more , Nagle-Yang SM, Dempsey AG
Community Ment Health J · 2026 Apr · PMID 41954875 · Publisher ↗
OBJECTIVE: To identify patient and system factors associated with metabolic lab monitoring for patients prescribed second-generation antipsychotics (SGAs) in an outpatient psychiatry setting. METHODS: This retrospective...
OBJECTIVE: To identify patient and system factors associated with metabolic lab monitoring for patients prescribed second-generation antipsychotics (SGAs) in an outpatient psychiatry setting. METHODS: This retrospective cohort study used electronic health record data from a large academic psychiatry clinic network (April 2019–April 2024). We included adult patients with at least one visit where a clinician ordered or refilled an SGA. Data included demographics, visit details, and laboratory results. Logistic regression estimated associations with receiving any monitoring, defined as a random glucose, glycosylated hemoglobin, or lipid test. Multiple logistic regression then jointly evaluated patient and clinic characteristics that could affect monitoring. RESULTS: Among 2,362 unique patients (14,135 encounters), 42.4% never received monitoring. People of older age, English as a preferred language, Black or African American Race, a Latine ethnicity, and any telehealth utilization were more likely to receive monitoring. CONCLUSIONS: In addition to confirming persistently low rates of SGA monitoring, this study is novel in identifying specific patient and system factors that influence with whether monitoring occurs. These findings provide insights into why previous improvement efforts may not have achieved widespread success and highlight the need for targeted interventions. Future efforts should address structural barriers to lab completion, including developing workflows for facilitating in-person laboratory measurement during existing appointments and developing EHR optimizations to support lab ordering for patients at greatest risk for not receiving monitoring.
Arrest Status, Suicide-Related Outcomes, and Moderating Social Factors: A Cross-sectional Study of a U.S. Sample (2015-2019).
Harvey TD, Lam B, Baskin-Sommers A … +4 more , Thomas KA, Wang EA, Winkelman TNA, Howell BA
Community Ment Health J · 2026 Apr · PMID 41954874 · Publisher ↗
Individuals impacted by the criminal legal system are at heightened risk for death by suicide. This study aimed to examine the association between arrest status and suicidal thoughts, suicide plans, and suicide attempts...
Individuals impacted by the criminal legal system are at heightened risk for death by suicide. This study aimed to examine the association between arrest status and suicidal thoughts, suicide plans, and suicide attempts among a nationally representative sample in the United States and investigate if this relationship is moderated by social factors. Data were from the National Survey on Drug Use and Health, a nationally representative cross-sectional survey of adults ≥ 18 years old (2015-2019). Logistic regressions were used to examine the relationship between arrest status (never arrested (n = 175,355), ever arrested but not in the past 12 months (n = 29,956), or recently arrested in the past 12 months (n = 5,865)) and suicidal thoughts, plans, and attempts in the past 12 months. Additional analyses explored social moderators (i.e., governmental welfare program receipt, food stamp receipt, financial security, health insurance) of the relationship between arrest status and suicidal thoughts, suicide plans, and suicide attempts. Recently arrested individuals experienced higher rates of suicidal thoughts, suicide plans, and suicide attempts compared to those ever and never arrested. In a fully adjusted model, recently arrested individuals were 5.4% percentage points (95% CI: 4.4-6.5%) more likely to report suicidal ideation, 3.4% percentage points (95% CI: 2.5-4.3%) more like likely to report suicide plans, and 2.6% percentage points (95% CI: 2.0-3.2%) more likely to report suicide attempts compared to never arrested individuals. Not receiving welfare significantly increased risk for suicide plans for those ever arrested compared to those never arrested. Arrest history is linked to risk of suicidal thoughts, suicide plans, and suicide attempts. Additional research is warranted to identify what social factors may play a protective or harmful role in suicide-related outcomes among people with past and recent criminal legal involvement.
"Acting as the Face of a Broken System": Challenges Experienced by Mobile Crisis Workers.
Gupta P, Jacobs L, Luk K … +1 more , Jones T
Community Ment Health J · 2026 Apr · PMID 41940892 · Publisher ↗
In 2020, United States federal legislation established the 988 Suicide & Crisis Hotline to divert mental health crisis calls away from standard emergency services, including law enforcement. The hotline’s creation has in...
In 2020, United States federal legislation established the 988 Suicide & Crisis Hotline to divert mental health crisis calls away from standard emergency services, including law enforcement. The hotline’s creation has increased interest in and demand for comprehensive crisis intervention services. Among these services, mobile crisis (MC) teams are a core component. Expanding MC services, however, requires understanding the needs of and supporting the MC workforce. To inform these efforts, this qualitative study draws on first-hand perspectives on the challenges of MC work expressed by a national sample of MC workers (n = 364). Findings indicate MC workers experienced challenges across five primary domains; challenges related to structural characteristics of MC work, resources, the workplace and workforce, provider mental health, and behavioral health (BH) and criminal justice (CJ) systemic factors. Further, findings indicate that challenges related to the structural characteristics of MC work effected or were often compounded by issues pertaining to resources, workforce, mental health, and systems. Results revealed the need for improvements in several areas, including betterment of working conditions through implementation of a trauma-informed work environment, clarification of agency policies and procedures, development of training standards, increasing role clarity between MC workers and collaborators, and increased investment in community mental health resources and service systems.
Clinical Characteristics of Emergency Visits Related to Recreational Psychedelic Use.
Bhatt KV, Friedman J, Benster L … +5 more , Narasimhan R, Yang K, Mishra J, Weissman CR, Ramanathan D
Community Ment Health J · 2026 Apr · PMID 41920509 · Publisher ↗
Recreational psychedelic use is increasing, yet data on adverse events remains limited. This study characterized emergency department (ED) visits associated with recreational psychedelic use at UC San Diego Medical Cente...
Recreational psychedelic use is increasing, yet data on adverse events remains limited. This study characterized emergency department (ED) visits associated with recreational psychedelic use at UC San Diego Medical Center. We conducted a retrospective chart review of ED encounters (2010–2023). Cases were identified using ICD-10 hallucinogen-related codes and confirmed through manual review. Multivariable logistic regression was employed to identify factors associated with psychiatric hospitalization. We identified 232 cases, primarily related to LSD (35.0%), MDMA (30.2%), and psilocybin (24.0%). The cohort was predominantly young, white, and male. Common psychiatric symptoms included agitation (25.9%) and anxiety (24.6%). Common nonpsychiatric symptoms included nausea/vomiting (9.5%) and diaphoresis (5.2%). 11.2% of cases required psychiatric hospitalization. Factors associated with psychiatric hospitalization included concurrent cannabis use (OR = 10.9, 95% CI 3.37–39.64), history of bipolar disorder (OR = 12.67, 95% CI 2.35–70.43), and history of a primary psychotic disorder (OR = 17.10, 95% CI 2.01–187.49). Psychedelic-associated emergency visits present with various clinical characteristics. While most recreational psychedelic presentations are effectively managed in the emergency department, specific factors predict severe outcomes. Concurrent cannabis use and pre-existing psychotic or bipolar disorders are associated with increased odds of psychiatric hospitalization, underscoring the importance of targeted risk assessment in patients with these vulnerabilities.
Clozapine Knowledge, Confidence, and Prescribing Practices Among Advanced Practice Psychiatric Nurses.
Manzour R, Lepore M, Palmer J … +2 more , Kameg K, Kameg B
Community Ment Health J · 2026 Mar · PMID 41915310 · Publisher ↗
Clozapine is the gold-standard treatment for treatment-resistant schizophrenia (TRS) but remains substantially underutilized in clinical practice. Advanced practice psychiatric nurses (APPNs) represent a growing segment...
Clozapine is the gold-standard treatment for treatment-resistant schizophrenia (TRS) but remains substantially underutilized in clinical practice. Advanced practice psychiatric nurses (APPNs) represent a growing segment of the psychiatric workforce, yet their knowledge, confidence, and prescribing practices related to clozapine have not been previously examined. A national cross-sectional survey was conducted among licensed psychiatric–mental health nurse practitioners and clinical nurse specialists practicing in the United States. The investigator-developed survey assessed demographics, clozapine-related knowledge, confidence, perceptions of risk, prescribing practices, and perceived barriers to clozapine use. Descriptive statistics summarized responses, and multiple linear regression examined predictors of confidence in clozapine management. A total of 155 APPNs completed the survey. Although most respondents reported prior clozapine-specific training and moderate to high levels of clozapine-related knowledge, the majority reported rarely or never prescribing clozapine. Fewer than one-quarter reported high confidence in initiating, titrating, or managing clozapine therapy. While most participants recognized clozapine as underutilized and perceived agranulocytosis as rare, only 20.5% reported being likely to prescribe clozapine following Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) elimination. Higher confidence was significantly associated with clozapine-specific training, prior initiation of clozapine, and more frequent prescribing, whereas knowledge level alone was not a significant predictor of confidence. Despite adequate knowledge, APPNs report limited confidence and clinical experience with clozapine, which may continue to impede its use following REMS elimination. Interventions emphasizing experiential learning, mentorship, and structured clinical support may be critical to improving clozapine access for individuals with TRS.
Reduction of Burnout in VA Mental Health Providers: Beyond Self Care.
Wood AE, Force JC, Caris MK … +2 more , Jaworski BK, Prins A
Community Ment Health J · 2026 Mar · PMID 41896516 · Publisher ↗
Introduction: Mental health care providers are at increased risk for burnout, particularly during times of increased environmental stress. Self-care mobile applications and mindfulness practices have been associated with...
Introduction: Mental health care providers are at increased risk for burnout, particularly during times of increased environmental stress. Self-care mobile applications and mindfulness practices have been associated with reduced burnout. Methods: This study examined the impact of COVID Coach (a self-care mobile app) on burnout among mental health care providers during the COVID pandemic. Additionally, two cohorts of mental health care providers were compared; one assessed prior to the pandemic and the other during its peak. Baseline burnout and mindfulness scores were analyzed across both cohorts. Results: During the height of the COVID pandemic in 2021, 43 mental health care providers from a VA medical center participated in a 30-day, pre-post pilot observational study of the COVID Coach mobile app. The majority (80.6%) of participants rated the app as beneficial; however, it was not associated with reductions in provider burnout or compassion fatigue. Regression analyses using baseline data from the two cohorts found significantly higher burnout in the pandemic cohort (b = 14.86, SE = 2.75, p < .001). A hierarchical regression found an interaction effect between mindfulness, burnout, and cohort, indicating that mindfulness (specifically, the ability to describe mindfully) was associated with reduced burnout in the pre-pandemic cohort, but not for the pandemic cohort (b = 4.52, SE = 1.65, p < .01). Discussion: Findings are preliminary but suggest that while mindfulness may be helpful in reducing mild levels of burnout, it may not be as beneficial in reducing more elevated burnout levels. Interventions beyond individual self-care may be needed to address higher levels of burnout during times of heightened stress.
Assertive Community Treatment and ACT-Derived Outreach Models: A Scoping Review of Adaptations, Fidelity and Outcomes.
Vega-Martínez S, Pabón-Carrasco M, Bola-Saiz G … +2 more , Marichalar-Mendia X, Unanue-Arza S
Community Ment Health J · 2026 Mar · PMID 41886042 · Publisher ↗
Severe Mental Illness (SMI) represents a significant public health challenge associated with long-term disability, premature mortality, and high social and health care costs. Assertive Community Treatment (ACT) is an int...
Severe Mental Illness (SMI) represents a significant public health challenge associated with long-term disability, premature mortality, and high social and health care costs. Assertive Community Treatment (ACT) is an intensive community-based model for people with SMI who have difficulty engaging with conventional services and are at high risk of repeated hospitalizations. Over time, this model has been adapted to meet diverse needs, contexts, and populations. To map and synthesize evidence on ACT and ACT-derived outreach models, including adaptations, fidelity-related characteristics, comparator conditions, and outcomes. Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, we searched Medline (PubMed), Web of Science, Cochrane Library, Scopus, CINAHL, PsycInfo, ProQuest, IBECS, and LILACS without year restrictions. Two reviewers independently assessed eligibility, with disagreements resolved by a third reviewer. The protocol was registered in the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/DPNYT ). We included 129 studies (1990–2023), comprising randomized controlled trials, descriptive studies, and quasi-experimental designs. Evidence came predominantly from high-income countries and included diverse populations. Alongside classic ACT/PACT, adaptations included Flexible ACT, early psychosis community intervention, forensic and homelessness-focused models, and integrated dual-diagnosis approaches. Implementation features, fidelity reporting, comparator services, and outcome measurement varied, particularly for recovery-oriented outcomes. ACT and ACT-derived outreach services represent a continuum of intensive community mental health care. Reduced inpatient service use and improved engagement were commonly reported, whereas quality of life, social inclusion, vocational outcomes, and recovery were more variable. Better reporting of intervention characteristics, fidelity indicators, and comparator conditions is needed.
Treatment of Youth with Trauma and Gender Incongruence: A Call for Clinical Integration.
Feldman H, Jankowski MK, Sternberg KF … +2 more , Bausha CE, Barnett ER
Community Ment Health J · 2026 Mar · PMID 41865232 · Publisher ↗
Transgender youth contend with conventional stressors and traumas at higher rates than their cisgender peers, and this accumulation of stressors can result in significant health and mental health disparities. Youth with...
Transgender youth contend with conventional stressors and traumas at higher rates than their cisgender peers, and this accumulation of stressors can result in significant health and mental health disparities. Youth with gender incongruence and/or who are impacted by trauma can have considerable overlaps in their clinical presentations (e.g., symptoms not attributed to the appropriate etiology, complications around disclosure) as well as in their strengths and protections. The likelihood of experiencing trauma, combined with these overlaps, provides rationale for an integrated approach to treatment. In this paper, we review the literature related to the interplay between conventional traumas, minority stressors, and gender incongruence. We also review existing clinical guidance for mental health clinicians treating youth experiencing both gender incongruence and traumatic stress. To date, this guidance mostly exists in separate bodies of literature and specialties. We present a rationale and call to action toward clinical models that address the needs of transgender youth and their families in an integrated way, grounded in trauma-informed, gender-affirmative care.
Reorienting the Way a Community Mental Health Service Responds to Suicide and Other Serious Incidents.
Abdalla N, Whitehead R, Hopkins L … +3 more , Denborough P, Barbara-May R, Kehoe M
Community Ment Health J · 2026 Mar · PMID 41863746 · Publisher ↗
Suicide and other serious incidents involving users of mental health services can have a deep and lasting effect on staff members who have been involved in the person’s care. It is important for the service to ensure tha...
Suicide and other serious incidents involving users of mental health services can have a deep and lasting effect on staff members who have been involved in the person’s care. It is important for the service to ensure that staff can learn and improve from these incidents while also minimizing the negative impacts on workers. One service has developed an innovative approach to reviewing and responding to serious incidents, using a dialogically informed, learning circle approach, based on the principles of restorative justice. This approach seeks to support staff to manage workplace stress and distress, while also acknowledging the person involved in the incident as well as the rights and needs of the family members and friends. It is intended that such an approach, rather than blaming staff, seeks to support them and build a service in which it is safe to practice in a person-centred, non-defensive way. This paper reports on the experiences of staff within this service who have taken part in this serious incident review process, and provides support for the roll out of the model as well as highlighting some of the pitfalls and difficulties in implementing such a model within current service structure guidelines. The project found that having a process which was supporting and not punitive enabled staff to feel supported to remain in the workforce and to improve their practice within a supportive, learning-oriented organisation.
Treatment for Comorbid Mental Health Disorders Among Patients Treated for Opioid Disorder: The Role of a Hub and Spoke Intervention.
Hodgkin D, Daily SM, Panas L … +3 more , Ritter G, Stewart MT, Reif S
Community Ment Health J · 2026 Mar · PMID 41860676 · Full text
This study assessed whether delivery of opioid use disorder (OUD) treatment through a hub and spoke (HS) model is associated with better adherence to psychotropic medication treatment, compared to usual treatment. Washin...
This study assessed whether delivery of opioid use disorder (OUD) treatment through a hub and spoke (HS) model is associated with better adherence to psychotropic medication treatment, compared to usual treatment. Washington State’s HS model required each network to include at least one mental health program, so we hypothesized that it would improve psychotropic medication adherence for people with both a mental health disorder (MHD) and an OUD. The study sample comprises adult Medicaid beneficiaries who had a diagnosis of depression or bipolar disorder in Washington during 2017–2019, who also received medication treatment for OUD. We computed rates for receipt of and adherence to relevant psychotropic medication, before and after regression-based adjustment for patient characteristics with propensity score weighting to mitigate potential selection effects. The key exposure was treatment at a HS program. Patients with bipolar disorder who were seen in HS programs were less likely than other patients to fill a mood stabilizer prescription in the 30 days post-index (predicted probability (PP) = 11.2% versus 17.8%, p = 0.012). However, the likelihood of achieving 80% adherence to mood stabilizers in the year post-index was higher among HS patients (21.6% versus 5.9%, p = 0.01). HS participation was not associated with depression treatment outcomes. HS participation does not appear to be associated with greater psychotropic medication use or adherence among patients with depression, while effects for bipolar disorder are mixed. It appears that the HS model’s focus on OUD treatment initiation did not generate much positive spillover for ongoing psychotropic medication treatment.
Bridging the Research to Practice Gap: Feasibility of Implementing Social Rhythm Therapy for Bipolar Disorder in Specialist Mental Health Services.
Inder ML, Crowe MT, Porter RJ
Community Ment Health J · 2026 Mar · PMID 41854950 · Publisher ↗
Introduction. Despite research evidence supporting adjunctive psychological treatment for bipolar disorder, there is often a failure in translation to routine clinical care. This study aimed to determine the feasibility...
Introduction. Despite research evidence supporting adjunctive psychological treatment for bipolar disorder, there is often a failure in translation to routine clinical care. This study aimed to determine the feasibility of implementing social rhythm therapy, a brief intervention with potential for adoption within Specialist Mental Health Services for individuals with bipolar disorder. Method. Case managers from two community mental health teams were trained to deliver social rhythm therapy to clients with bipolar disorder on their case load. Feasibility was based on qualitative and quantitative data addressing acceptability of training, ability to deliver therapy as part of a caseload, and adherence and fidelity for case managers, and acceptability of therapy including recruitment and retention for case managers and clients. Descriptive analyses were used for quantitative data and thematic analysis for qualitative data. Results. Ten case managers were trained with eight delivering the therapy. Of 37potential clients with bipolar disorder, 10 began therapy (27% uptake),with five completing (50% completion). Qualitative findings demonstrated acceptability of training with implementation challenges associated with engaging clients and balancing case management requirements with high workplace demands. Limitations included the small sample size and significant gaps in data, especially reflecting the clients’ perspectives. Conclusion. The feasibility of implementing of social rhythm therapy in Specialist Mental Health Services was impacted by low level of uptake and systemic barriers, primarily related to the requirements inherent in the case manager role. Effective implementation requires addressing the systemic issues and enhancing engaging individuals with bipolar disorder in psychological treatment approaches.
When to Halt Implementation: Barriers in a Lay Counselor Narrative Exposure Therapy Training Program.
Bialas A, Meyer D, Orr J … +3 more , Arman A, O'Connor MH, Owen-Smith A
Community Ment Health J · 2026 Mar · PMID 41851586 · Publisher ↗
Narrative Exposure Therapy (NET) shows promise for addressing trauma among refugee populations when delivered by lay counselors, but implementation barriers in real-world settings remain understudied. This study examined...
Narrative Exposure Therapy (NET) shows promise for addressing trauma among refugee populations when delivered by lay counselors, but implementation barriers in real-world settings remain understudied. This study examined the implementation of a lay counselor NET training program in a U.S. refugee community, focusing on barriers that led to halting scale-up efforts before community delivery. Community members (n = 23) participated in a three-day NET training followed by supervision sessions. Implementation barriers and facilitators were assessed through semi-structured interviews with trainees (n = 10) and trainers (n = 3), analyzed using rapid qualitative analysis guided by an implementation science framework. Pre-training surveys provided participant demographic and psychosocial context. Despite initial enthusiasm and participants’ strong psychosocial functioning, multiple implementation barriers emerged that prevented progression to community service delivery. Only four of 23 trainees (17%) continued to supervision. And none progressed to independent practice. Key barriers included unresolved trauma among trainees, time constraints due to competing work responsibilities, unclear expectations about post-training requirements, and lack of compensation structures. The research team made the decision to halt implementation due to safety and feasibility concerns. The decision to halt scale-up highlights critical implementation considerations for trauma-focused lay counselor programs. Essential requirements include rigorous screening for emotional readiness, clear communication about complete training pathways, integration of NET delivery into existing job roles, and sustainable compensation and support structures. This study demonstrates the importance of systematic implementation monitoring and data-driven decisions about program continuation in community mental health initiatives.
Facilitating Personal Recovery in the Community: a Qualitative Evaluation of a Peer Support Group for Adults with Severe Mental Health Challenges in Rural Australia.
Isaacs A, Baker A
Community Ment Health J · 2026 Mar · PMID 41820743 · Publisher ↗
Individuals with severe mental health challenges [SMHCs] often have unmet needs that are beyond the scope of traditional mental health services. These needs are typically met by community agencies, charities and peer sup...
Individuals with severe mental health challenges [SMHCs] often have unmet needs that are beyond the scope of traditional mental health services. These needs are typically met by community agencies, charities and peer support groups. Happy Chat [HC] is one such peer-support group whose goal is to address social isolation, and loneliness by creating a safe space to facilitate the development of informal friendships among individuals with SMHCs in the community. Nineteen participants were interviewed as part of a qualitative evaluation of HC. Data were subjected to thematic analysis. Four categories emerged from the data. They were: Difficulties faced by persons with SMHCs (6 codes), Supports provided by HC (15 codes), Outcomes achieved (15 codes) and Continuing challenges (4 codes). Key supports reported by participants included a welcoming and non-judgemental space, that is inclusive and safe, continuing human connections, ongoing social, emotional and general support, as well as support and care during a crisis. Key outcomes reported by participants included improved confidence and motivation to leave the house, having a place of comfort and a sense of belonging, improved self-care, and social life, a new identity, and a renewed sense of hope and purpose. Four supports and one outcome were identified as being more closely aligned to the CHIME framework of personal recovery. Ongoing challenges reported by participants such as limited funding, are common in small, resource-limited peer support groups. Further research is needed to demonstrate any association between meeting basic and psychosocial needs and achieving personal recovery among individuals with SMHCs.
The Young Ones, pre-post results of a transdiagnostic ACT-training for adolescents with Severe Mental Illness.
Helmus KL, Vink JD, Schirmbeck F … +3 more , de Koning MB, Germeys I, de Haan L
Community Ment Health J · 2026 May · PMID 41793605 · Full text
Young adults with severe mental illness (SMI) often face significant barriers to accessing mental health care, including (self)-stigmatization, social withdrawal, and a lack of appropriate treatment programs. These chall...
Young adults with severe mental illness (SMI) often face significant barriers to accessing mental health care, including (self)-stigmatization, social withdrawal, and a lack of appropriate treatment programs. These challenges underscore the need for recovery-oriented interventions tailored to the developmental needs of this population. The aim of this study was to evaluate Acceptance and Commitment Therapy (ACT), with its focus on psychological flexibility and values-based action, for young adults with SMI. This pre-post pilot evaluation assessed the indications for feasibility, and preliminary outcomes of The Young Ones (TYO), an eight-week, ACT-based, transdiagnostic group intervention designed for young adults with SMI. Outcomes included personal recovery, functional impairment, psychological flexibility, and self-stigmatization. To evaluate change over time, we conducted separate Linear Mixed Models (LMM) for each outcome measure using an intention-to-treat (ITT) approach. Of 101 eligible participants, sixty-one individuals enrolled in the research, and 33 completed both pre- and post-measures (46% attrition). Significant improvements were observed in personal recovery and functional impairment. No significant changes were found for psychological flexibility or self-stigmatization. TYO appears feasible and acceptable for young adults with SMI, with promising indications of benefit in personal recovery and daily functioning. While dropout remains a concern, these preliminary findings support the need for a randomized controlled trial to rigorously evaluate the effectiveness of ACT-based group interventions for this population.
Ensuring High Quality Oyster Care for People Experiencing Severe and Persistent Mental Illness - A Three-Phase Development of A Quality Monitoring Tool.
Van Hoe C, Moureau L, Leemans K … +5 more , Decorte I, Voskes Y, Beirnaert L, Liégeois A, Chambaere K
Community Ment Health J · 2026 Mar · PMID 41792414 · Publisher ↗
INTRODUCTION: Oyster Care is an innovative care model designed to meet the needs of people experiencing severe and persistent mental illness. A population often overlooked within healthcare systems and at heightened risk...
INTRODUCTION: Oyster Care is an innovative care model designed to meet the needs of people experiencing severe and persistent mental illness. A population often overlooked within healthcare systems and at heightened risk when care becomes either ineffective or prematurely discontinued. In recent years, the adoption of Oyster Care principles has gained attention within Flemish mental health care. Consequently, there is growing recognition of the need for a tool that supports the consistent implementation of Oyster Care model and provides caregivers with clear, actionable guidance to improve care quality. METHODS: A mixed-methods study was conducted between 2021 and 2023 within Flemish residential mental health care services. The study consisted of three sequential phases. In the first phase, a literature review and qualitative research were undertaken to identify and explore the core principles of the Oyster Care model. In the second phase, these principles were translated into operational indicators and validated through a Delphi expert consensus process. In the final phase, experts prioritized and selected the most relevant indicators for inclusion in the Oyster Care monitor. RESULTS: The monitor consists of 79 indicators of high-quality Oyster Care. These indicators are grouped into 24 sub-themes, and organized under eight overarching themes: The care process; The somatic pillar; The psychological pillar; The social pillar; The existential pillar; End-of-life care; Team vision, culture, and development; The living environment. The SCV-I demonstrated 97% for clarity and 93% for relevance. DISCUSSION: The monitor enables teams to assess and guide the implementation of the Oyster Care model within their own practice. By systematically evaluating care practices, teams can gain objective insights into their performance and identify areas for improvement. CONCLUSION: The monitor is both theoretically sound and practice-based, adapted to the specific imperatives of Oyster Care and applicable in the real context of residential mental health care in Flanders.
Predictors of Engagement in a Multicomponent Community-Based Intervention Alongside Drug Treatment Court for People with Co-Occurring Mental Health and Substance Use Disorders and Criminal-Legal Involvement.
Shaffer P, Andre M, Helm A … +3 more , Casey S, Fitzpatrick C, Smelson D
Community Ment Health J · 2026 Mar · PMID 41784876 · Publisher ↗
Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking–Criminal Justice (MISSION-CJ) is a multicomponent intervention designed for individuals with co-occurring mental health and subs...
Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking–Criminal Justice (MISSION-CJ) is a multicomponent intervention designed for individuals with co-occurring mental health and substance use disorders (COD). This study examined client engagement in MISSION-CJ when delivered alongside two Drug Treatment Courts (DTCs) and identified factors that predicted engagement. We further assessed whether predictors of engagement differed between the pre–COVID-19 public health emergency (PHE) and during the PHE. We hypothesized that overall engagement would be lower during the PHE due to service disruptions and that participants with greater behavioral and social needs would demonstrate lower engagement. Using a quasi-experimental, single-group open pilot design, we analyzed engagement data from 90 participants enrolled in MISSION-CJ. The sample was 64.1% male, 82.8% White, 67.8% unemployed, 83.9% unstably housed, with a mean age of 34 years. Minority status, older age, and female gender were significant demographic predictors of higher engagement. Social determinants of health, including employment, housing stability, and comorbid chronic medical conditions, were also associated with greater engagement. Increased participation in telehealth sessions further predicted higher levels of engagement in MISSION-CJ overall and across program components. Engagement did not differ significantly between pre-PHE and PHE periods, suggesting that MISSION-CJ maintained stable client participation despite widespread service disruptions. These findings highlight the importance of demographic, social, and service delivery factors in shaping engagement and underscore the potential of telehealth to support COD treatment within DTCs. Future research should examine strategies to leverage these predictors to further improve engagement.
Implementing Point-of-Care Fingerstick Testing for Clozapine Safety Monitoring in Outpatient Psychiatry: A Convergent Mixed Methods Study.
Foo CYS, Lim C, Leonard CJ … +4 more , MacLaurin SA, Cather C, Donovan AL, Freudenreich O
Community Ment Health J · 2026 Mar · PMID 41770420 · Publisher ↗
OBJECTIVE: This study assessed the real-world adoption of a point-of-care fingerstick testing device for blood monitoring for absolute neutrophil count in clozapine-treated patients at two outpatient psychiatric clinics....
OBJECTIVE: This study assessed the real-world adoption of a point-of-care fingerstick testing device for blood monitoring for absolute neutrophil count in clozapine-treated patients at two outpatient psychiatric clinics. METHODS: Adoption rates and acceptability were assessed with electronic health record data and patient surveys. Implementation determinants were identified via rapid thematic analysis of staff interviews. RESULTS: 22% (10/45) of clozapine-treated patients at a specialized psychosis treatment program and 60% (120/199) at a community mental health center used fingerstick testing at least once. Among survey respondents (n = 86), infrequent users (36%) and non-users (56%) cited not wanting to change care, and perceived greater pain/inconvenience with fingerstick testing versus venipuncture. Non-users had taken clozapine for about seven years longer than those who tried fingerstick testing. Implementation barriers included provider burden and lack of reimbursement mechanisms; facilitators included designated personnel for test administration. CONCLUSIONS: Successful implementation of fingerstick testing for clozapine safety monitoring requires planning to address patient preferences, staffing logistics, and sustainable financing strategies.
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