Wendy M. M. Albers

Background: Financial stability is essential for well-being, influencing health, housing, education, and social participation. Individuals with mental illness often face financial hardship, including debt, financial administration problems, and limited access to basic needs. Despite its importance, little research exists on factors supporting financial self-management for this group. This study explores financial hardship experiences, causes, and support mechanisms among clients in supported accommodation in the Netherlands. Methods: Twenty-seven clients were recruited via staff of a large supported accommodation setting in the Netherlands, of which 22% received residential support and 48% received floating outreach. Semi-structured interviews were conducted, and thematic analysis was used to interpret participants’ lived experiences with financial problems. Results: Participants identified several causes for their financial struggles, including psychological issues, impulsive spending, and a lack of financial literacy. Relationship problems (e.g., divorce) and limited social support also were mentioned to contribute to ongoing financial hardship. Budget coaches, professionals with expertise in debt management, offer personalized guidance and practical assistance with financial management, including creating budgets, managing expenses, and addressing debts. This support was highly valued by clients, helping them to organize their finances, manage expenses, reduce stress, and develop their financial literacy. Conclusions: This study highlights the complex and multifaceted nature of financial difficulties experienced by clients in supported accommodation. Budget coaches, with their specialized knowledge of the target population and financial expertise, can play a crucial role in improving the financial situation of individuals with mental illness. The findings underscore the need for integrated support addressing both financial and mental health challenges to promote long-term independence and well-being for this vulnerable population in the Netherlands.

Geïnspireerd door het format van Current Opinion-tijdschriften bespreken de auteurs in deze bijdrage trends in de wetenschappelijke literatuur en daarnaast recente inzichten uit praktijkgerichte publicaties vanuit kennisinstituten en expertisecentra over financiële problemen bij mensen met psychische aandoeningen in Nederland. Methodologische keuzes in de literatuur en bestaande interventies en hun toepasbaarheid bij mensen met ernstige psychische problemen komen aan bod. De inzichten worden in internationaal perspectief geplaatst.

Purpose: Due to the deinstitutionalization, many individuals with severe mental illness are able to live independently nowadays, by making use of supported accommodation. The financial well-being of these individuals significantly influences their overall quality of life, yet this aspect remains underexplored. This study aims to enhance the understanding of the financial circumstances of supported accommodation clients and the specific support mechanisms they rely on. Design/methodology/approach: This investigation involved an examination of electronic patient records from a large supported accommodation organization. Additionally, an online questionnaire was distributed to staff members to elucidate the prevalence of financial support among clients, the nature of such support and the extent of financial challenges they face. Findings: In total, 25% of clients were found to be in debt, with a majority carrying debts exceeding €5,000. Financial support was extended to over half of the supported accommodation clients. Notably, 17% of clients with intricate financial issues were assigned to a budget coach. The most common forms of support included assistance with financial administration and protective guardianship, whereas clients with more complex problems primarily received support in budget management and financial skill development. Originality/value: This study highlights a significant prevalence of financial challenges among supported accommodation clients. Recommendations include investing in staff training programs to further develop knowledge and skills. Additionally, the effectiveness of current financial support initiatives requires further investigation.

Background: Individuals with severe mental illness experience more victimization and discrimination than other persons in the community. Effective rehabilitation and recovery-oriented care interventions aimed at addressing this issue are lacking. We therefore developed a victimization-informed intervention (accompanied by a training module for professionals) called the Victoria intervention. The purpose of the present study was to understand the trial effects by examining the implementation process and the factors that influenced it.Materials and methods: A process evaluation was conducted using a mixed-methods design. During the professionals’ intervision sessions, we used observations to understand the learning processes (n = 25). Subsequently, we studied the use of the intervention in practice through structured questionnaires (n = 215) and semi-structured interviews (n = 34) with clients and professionals. We used descriptive and inferential statistics for the quantitative data and the framework method for the analyses of the qualitative data.Results: The observations showed that the trainings were well received. The professionals shared the urgency of paying attention to victimization and discrimination and its harmful effects on participation. They also found the intervention steps to be logical and the intervention protocol easy to use. Nevertheless, they mentioned in the interviews that they had experienced difficulties initiating a conversation about victimization, and if they started one, they did not always follow the steps of the intervention as intended. Few clients said that victimization was placed on the agenda, though those who had discussed victimization with their caregivers expressed their appreciation in the interviews; they felt acknowledged and supported.Discussion: The findings indicate that the intervention was considered helpful in raising awareness and the acknowledgment of victimization. However, professionals remain reluctant to talk about the subject, and the results show they need more practical training in this regard. This process evaluation has an important added value in that it helps us to understand the results of the effect evaluation of the intervention. The findings will facilitate the development and implementation of interventions that address clients’ victimization experiences in community mental healthcare settings and subsequently enable their participation in society.

Objective: Individuals with severe mental illness often face (anticipated) discrimination and (criminal) victimization, which have severe consequences for their social participation. The aim of the present study is to assess the effectiveness of a new intervention to manage and prevent revictimization, and to support safe participation by recognizing and acknowledging the impact of their victimization experiences. Method: A multicenter cluster randomized controlled trial was performed by following clients from four intervention teams and four teams providing care as usual. The primary outcomes were social participation, victimization, and discrimination. The secondary outcomes were acknowledgment of difficulties, self-efficacy and empowerment, quality of life, and psychosocial functioning. Data were collected at baseline, and after 10- and 20-month follow-ups. The data were analyzed according to the intention-to-treat principle using linear mixed models and generalized estimating equations. In total, 400 clients were included in the analyses: 216 in the intervention group and 184 in the control group. Results: For experienced discrimination and acknowledgment of difficulties and recovery support, we found small but significant time by condition interactions after 20 months. Both experienced and anticipated discrimination, and self-efficacy increased slightly in both groups. No significant differences were found for other outcome measures. Conclusions and Implications for Practice: The intervention had no effect on victimization and participation, but there were indications that it was successful in moderating experienced discrimination. The clients also felt significantly more acknowledged and supported in their recovery process. Further development of the intervention is needed, and future research should focus on improving implementation.

Individuals with severe mental illness have a significant risk of (anticipated) discrimination and (criminal) victimisation, which is not structurally and systematically addressed by mental health practitioners. The aim of this study was to develop and pilot an intervention which supports professionals to address victimisation and its consequences, in order to reinforce safe social participation and improve recovery. Following the rehabilitation and positive risk management literature, in addition to current practice, intervention components were developed in two focus groups and four subsequent expert meetings. The intervention was piloted in two outpatient teams before being finalised. The Victoria intervention includes positive risk management, focusing on clients’ narratives and strengths, and awareness of unsafe (home) environments: it comprises four steps: exploring issues with social participation, analysing victimisation experiences, clarifying the context of these experiences, and determining future steps, including victimisation-sensitive rehabilitation planning and optional trauma treatment. Future research should further test this intervention.

Persons with severe mental illness are more prone to victimization and experience more difficulties regarding societal participation than other community members. These experiences vary greatly among individuals. Community mental health care should offer more individualized support by addressing these differences in experience. Therefore, this study aimed to identify subgroups of outpatients with severe mental illness based on their experiences of social participation and victimization. Data from patients with severe mental illness from eight outpatient teams in the Netherlands were used to perform latent class analysis. From the total caseload, 395 patients agreed to participate. Classes were based on: i) criminal victimization incidents, ii) criminal perpetration incidents (Dutch Safety Monitor), iii) experienced discrimination (DISC-12), and iv) social functioning (Social Functioning Scale). Also, to investigate differences between the classes, socio-demographic, clinical, and person-related variables were examined. Three classes were identified. The Victimized and Perpetrating class (34.4%) had the highest prevalence of discrimination, victimization, and perpetration, and intermediate scores on social functioning subscales. This class also experienced the most problems in other domains, such as psychosocial functioning and quality of life. The Discriminated and Avoiding class (36.4%) had moderate scores for discrimination, victimization and perpetration, and the lowest scores for social functioning and social support. The General Difficulties class (28.8%) had the lowest prevalence of discrimination, victimization, and perpetration, and the highest scores on social functioning. These distinct classes offer new insights to mental health professionals in outpatient teams in in their aim to positively influence the patient’s social context during rehabilitation; this includes addressing the role of victimization, and indicates the relevance of distinctive approaches and the support needed for each class. Professionals may need to focus more on the impact of difficulties in their patients’ social context to adequately support them in the rehabilitation process.

People with severe mental illness (SMI) are more likely to experience criminal victimization than other community members. In addition, (self-) stigma and perceived discrimination are highly prevalent in this group. These adversities in the social context often have major adverse effects on the rehabilitation and recovery of these persons. Current practice, however, lacks instruments to address these issues. As a reaction, the Victoria intervention was developed and pilot-tested with client representatives, professionals, trainers and researchers. The Victoria intervention is a method for community mental health care workers to expand their awareness of this topic and support them in assessing victimization and incorporate appropriate services, including trauma screening and rehabilitation services, in their health care planning. For clients, the Victoria intervention aims to increase their awareness, active management of possible victimization risks and promote safe social participation. As a new intervention, little is known about its use in real practice and its effects on client outcomes. To determine the feasibility and effectiveness of this intervention, a process evaluation and a first cluster randomized controlled trial (RCT) will be carried out. Outpatients from eight Flexible Assertive Community Treatment (F-ACT) teams from two mental health care (MHC) organizations in the Netherlands are included in the study. Teams in the intervention group will receive three half-day training sessions, and bi-monthly supervision meetings for 18 months. Teams in the control group provide care as usual. For the process evaluation, a multi-method design is used. To assess effects on client outcomes, clients will be interviewed about their experiences on victimization and societal participation using validated questionnaires at baseline, and after 9 and 18 months. This study is the first to evaluate an intervention aiming at recognition of victimization, (self-) stigma and perceived discrimination, and targeting outpatients’ insights into possible risks and coping skills to tackle these risks to enhance safe societal participation. Results of this study may validate the Victoria intervention as a practice to better manage risk for adversities related to societal participation. Dutch Trial Register (NTR): 5585 , date of registration: 11–01-2016.