Court-Ordered Treatment (COT) is used to address treatment non-adherence and psychiatric readmission in individuals with serious mental illness (SMI), who are at risk for treatment non-adherence and recurrent psychiatric hospitalization. Evidence regarding clinical outcomes associated with COT remains mixed, partly due to differences in legal frameworks and program implementation. To compare psychiatric readmission, outpatient appointment attendance, and long-acting injectable (LAI) medication adherence during COT and during the year following COT expiration in Arizona’s public behavioral health system. This exploratory, retrospective chart review identified 94 patients placed on COT between 2020 and 2021. Paired within-subject analyses included 29 patients whose COT expired and who completed a full one-year follow-up after COT expiration. Outcomes during COT were compared with outcomes during the year after COT expiration. Among the 29 patients analyzed, psychiatric hospital admission rates rose significantly from 10.3
Adults with serious mental illness (SMI) experience disproportionately high rates of chronic medical disease and premature mortality, making primary care engagement essential. Although the presence of a primary care provider (PCP) is frequently used as a marker of healthcare access, whether patients hospitalized with SMI meaningfully engage with primary care remains unclear. A retrospective chart review of 278 adults admitted to an inpatient psychiatric unit with major depressive disorder, bipolar disorder, schizophrenia, or schizoaffective disorder was conducted. We examined the prevalence of an identified PCP, PCP utilization within the 12 months preceding hospitalization, and demographic and clinical characteristics associated with PCP engagement. Overall, 64.4
Psychiatric caseworkers provide direct support to individuals with severe mental illness, yet they often have limited formal clinical training, leaving them vulnerable to burnout. Balint groups have been shown to reduce burnout, enhance empathy, and improve provider–patient relationships but studies often focus on physicians and resident trainees. This Quality Improvement project sought to examine the feasibility and acceptability of Balint groups for reducing burnout in psychiatric caseworkers at an urban safety net community mental health center. Fourteen caseworkers employed at an urban safety-net community mental health center voluntarily participated in biweekly Balint groups and completed anonymous assessments of burnout, depression, anxiety, along with group feedback surveys. One participant did not complete baseline burnout assessments. Ten of 13 participants reported burnout via emotional exhaustion at baseline and over half of participants reported moderate anxiety at baseline (n = 8). Ten participants completed follow-up assessments. Most reported at least some improvement in job satisfaction, self-reflection, and awareness of limitations. Formally assessed burnout did not significantly change at follow-up. Anxiety was significantly decreased from baseline to follow-up (median 24 vs. 22.5, p = .036). Balint groups were feasible and well-accepted by psychiatric caseworkers in our healthcare setting. Nearly 90
People living with a mental health diagnosis are less likely to have their physical healthcare needs met. This may be because of barriers to healthcare including stigma and discrimination on the part of clinicians and delayed or missed diagnosis. People with mental and physical health concerns living in rural and regional areas are disproportionately impacted by a lack of access to appropriate healthcare. This study explored consumer and carer perspectives on existing mental and physical healthcare in rural and regional areas, and on the forms of support they valued across clinical, allied health, and lived experience workforces. Sixty people took part in focus groups and interviews: 32 people with mental and physical health concerns identified as consumers, 21 family members, friends, or other informal supporters identified as carers, and 7 participants identified as both consumers and carers. We identified the following themes: fragmentation in health services, need for holistic support, experience of being cared about, and power and advocacy. The key finding was that participants had a strong preference for working with professionals who would act in line with their wishes, and therefore valued peer workers who offer lived experience expertise in this role. Our study suggests that participants found it difficult to have their healthcare needs met when working directly with both mental and physical health focussed clinicians, including allied health workers. These findings support the role of lived experience expertise in healthcare. The findings also suggest the need for reform in physical healthcare provision to prevent and address barriers, particularly stigma and discrimination.
