Evidence "serious mental illness"

The authors describe how two organizations have partnered together to provide integrated primary and mental health services through two Integrated Health Care (IHC) clinics. This project brings IHC into community settings by using nurse practitioner house calls, group primary care visits and tele-monitoring. Tele-monitoring enhances both the efficiency and effectiveness of physical health care specifically targeted at improving adherence to medication regimes and lifestyle changes and monitoring clinical parameters of physically unstable members with diabetes, obesity, and/or hypertension. These services target high-risk Thresholds clients who are not regularly accessing primary care. This report concludes that primary care outreach has not only helped to connect with hard to reach clients, but it has also further improved the integration of mental health and primary care.

Keywords: behavioral health care chronic care model integrated primary mental health services primary care serious mental illness tele-monitoring module 4

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This article evaluated the impact of training one ACT team in CBT techniques. This retrospective study found an ACT team who was trained in CBT would utilize CBT interventions with their clients, even after training. However, CBT interventions did not increase medication adherence or result in reductions in crisis visits and hospitalizations. Staff reported that the training was helpful in helping them better understand clients’ problems, increasing their self-confidence in dealing with clients’ problems, and improving their interventions with clients. However, they also identified several barriers to the use of CBT interventions, and these were: (a) the change in individual caseloads for some team members over time, (b) having to play multiple roles, such as driving, being an advocate, helping with shopping, and being a therapist, and (c) having to deal with crises and unexpected issues and not being able to focus on one problem. Another challenge mentioned was that clients had multiple needs and different team members were addressing different needs and this interfered with the continuity of therapy. The ACT psychiatrist and certified cognitive therapist, trained the rest of the ACT team in CBT techniques. Training consisted of 13 h of didactic and experiential training spread over a 6-month period. The training was based upon an unpublished CBT manual for case managers. The didactic training consisted of introduction to cognitive theory, cognitive case conceptualization, adapting cognitive therapy for SMIs and incorporating techniques into routine practice. The experiential training included learning various techniques, such as Socratic questioning, identifying and enhancing coping skills for positive psychotic symptoms, role-playing, and cost-benefits analysis. In addition to the didactic training, individual supervision was provided as needed and amounted to an hour every 2 weeks during the course of the study period.

Keywords: psychotherapy serious mental illness case management psychosocial treatments evidence based practice and outcomes cognitive-behavioural therapy (cbt) module 4

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