Philip Theodore Yanos

Mental health emergency response (initiated after calling centralized phone systems such as 911 in the United States and Canada) is a highly impactful, but understudied, component of the mental health service system. The present study used qualitative methods to examine the experience of receiving mental health emergency services and explore recommendations to improve future response. Twenty-three persons from New York City who self-identified as having interacted with mental health emergency services completed in-depth interviews and detailed 40 incidents of receiving mental health emergency services; interviews were analyzed using a deductive analytic approach. Major themes included participants perceiving responders as aggressive and using some type of force (including the act of putting on handcuffs). Participants typically reported being hospitalized, with roughly half of participants reporting dissatisfaction with the outcome. Prominent themes included experiencing aggression from police and feeling stigmatized by responders, while others experienced fair treatment from police officers and experienced them as professional and non-threatening. Participants felt that emergency mental health responders should be curious, conversational, non-judgmental and not aggressive, and that responders should primarily be comprised of mental health professionals and peers. Findings have important implications for how the mental health service system responds to perceived emergencies, and suggest that alternatives to traditional police-based responses need to be more widely implemented.

Purpose: There is evidence that anticipated and self‐stigma are associated with decreased engagement in first episode psychosis (FEP) treatment. It is therefore plausible that addressing stigma in FEP treatment could potentially improve treatment engagement and facilitate outcomes related to recovery. Narrative Enhancement and Cognitive Therapy (NECT) is a structured group‐based intervention that has been found to be effective at reducing self‐stigma among persons diagnosed with severe mental illnesses in multiple RCTs; however, a review of the manual determined that it was not appropriate for use with people with FEP in its standard form. The purpose of the present study was to adapt NECT for FEP youth and determine its acceptability/feasibility. Basic Procedures: We discuss the process of manual adaptation, including: optimising fidelity, optimising fit, balancing fidelity and fit, and pilot testing. Acceptability and feasibility were assessed as a function of treatment fidelity, attendance, and treatment satisfaction in an initial implementation (using a modified version of the Narrative Evaluation of Intervention Interview [NEII]). A case example of a group implementation is also presented. Main Findings: Mean overall fidelity ratings were good (4.33 on a 1–5 scale); among the three participants who attended at least one session, attendance was acceptable, with 77.8% of scheduled meetings attended. Findings from the NEII revealed that all participants perceived benefit from the intervention. Principal Conclusions: Findings supported the potential acceptability and feasibility of the adapted form of NECT geared towards youth who have experienced FEP (NECT‐YA).

Despite the effectiveness of targeted first episode psychosis services, a significant proportion of youth referred to such services do not engage in them. Youth (a group at the transition between adolescence and adulthood) is a particularly crucial phase of development related to identity formation, and therefore may be one in which stigma related to psychosis strongly impacts self-definitions. It has been proposed that awareness of and sensitivity to negative stereotypes, such as people with psychosis cannot recover, may predict early disengagement from targeted first episode psychosis services. The purpose of the present study was to explore the relationship between experiences of stigma and service engagement in the narratives of both youth with first episode psychosis (FEP) and their family members. We conducted qualitative interviews eliciting detailed accounts on both stigma and the help-seeking process among youth and family members (N=23, 14 youth and 9 family members). Interviews focused on the experiences of stigma concern and self-stigma in FEP, and how they impact treatment engagement and identity development. Open-coding analyses revealed that youth with FEP and family members reported themes of experiencing, anticipating, and internalizing stigma, and that concern with stigma was associated with increased ambivalence and reduced willingness to engage in treatment. Findings support that it is essential to address stigma in FEP services to improve treatment engagement.

Impact and Implications Individuals with serious mental illnesses (SMI) and co-occurring posttraumatic stress disorder (PTSD) have high rates of unemployment. This study investigates the ways PTSD interferes with employment among persons with SMI. Findings illustrate several ways on how trauma can affect career development for persons with SMI. Addressing trauma symptoms as a key barrier to career development and employment for clients with SMI receiving employment services is crucial to ensure successful outcomes. Objective: There is evidence that posttraumatic stress disorder (PTSD) is a hidden barrier to employment among individuals with serious mental illnesses (SMI) among whom PTSD is highly prevalent. This study aimed to explore how PTSD interferes with achieving employment outcomes among persons with SMI. Methods: Participants included 119 individuals with SMI and co-occurring PTSD receiving Supported Employment services. Responses to the question, "In what ways are PTSD symptoms interfering with your work during the past month?" were analyzed. Results: Six themes emerged: (a) I don't like being around people, (b) I feel frozen and unable to get started, (c) troubling negative affect, (d) mind is scattered and all over the place, (e) feeling fatigued all the time, and (f) flashbacks and triggers can happen whenever. Conclusions and Implications for Practice: Findings provide insight into how PTSD symptoms impact work outcomes and suggest that there is a need for Supported Employment providers to screen clients for trauma exposure to identify those in need of additional support in order to improve work outcomes.

Background: Persons with serious mental illnesses (SMIs) are at increased risk for exposure to trauma and posttraumatic stress disorder (PTSD). Prolonged Grief Disorder (PGD) may also impact this population but has been seldom studied.Aims: The present study investigated the rate of both PTSD and PGD among clients receiving community mental health services, and the clinical correlates of co-occurring PTSD/PGD.Methods: Trauma history, PTSD and PGD were assessed among 536 individuals receiving community mental health services (Study 1). A subsample of 127 individuals from Study 1 who met DSM-5 criteria for PTSD based on diagnostic interview completed measures of psychiatric symptoms (Study 2).Results: In Study 1, 92.4% of participants receiving community mental health services had experienced a traumatic event, 49.6% met criteria for probable and provisional PTSD, 14.7% scored positive for probable PGD, and 11.9% met criteria for probable and provisional PTSD as well as probable PGD. In Study 2, participants meeting diagnostic DSM-5 criteria for PTSD and probable PGD had more self-reported PTSD symptoms, but did not differ on other outcomes.Conclusions: Findings highlight the need for trauma informed services including grief counseling for persons with SMI.

Objectives: Members of historically marginalized racial and ethnic groups are more likely to experience racial and ethnic microaggressions (REMs), as well as to endorse greater mental health stigma. The present study examined whether the experience of REMs partially explains a greater likelihood of endorsing mental health stigma among members of marginalized groups. Method: 494 undergraduate students and MTurk workers completed a survey including measures of the experience of REMs, mental health symptoms, and mental health stigma (including mental illness microaggressions [MIMs]). Analyses examined the association between the experience of REMS and mental health stigma, and whether REMS mediated the relationship between race/ethnicity and mental health stigma. Results: Black/African-American participants endorsed experiencing significantly more REMs than participants from other racial/ethnic groups, while both Latinx and Black/African-American participants endorsed a greater willingness to engage in MIMs. REMs significantly predicted intent to perpetrate MIMs; however, mediational analyses did not support that REMs mediated the relationship between race/ethnicity and MIMs. Discussion: Findings suggest that the experience of REMs may predispose individuals to “pass along” discrimination that they have experienced to persons diagnosed with mental illness, but this relationship does not explain why members of racial and ethnic minorities may express more mental health stigma.

Objective: The Illness Identity model posits that self‐stigma reduces hope and self‐esteem among persons with severe mental illnesses, impacting a range of outcomes. The “insight paradox” anticipates that the negative effects of self‐stigma are amplified by insight. This study tested these predictions using both cluster and path analyses.Method: A total of 117 participants meeting the criteria for schizophrenia‐spectrum disorders completed measures of self‐stigma, self‐esteem, hopelessness, insight, social functioning, coping, and symptoms.Results: Cluster analysis supported the insight paradox; persons with low self‐stigma/high insight had fewer psychiatric symptoms and better interpersonal functioning than persons with high self‐stigma/low insight. Path analysis did not support the insight paradox, but indicated that self‐stigma and insight impact different outcomes.Discussion: Findings suggest that support for the predictions of the Illness Identity model and insight paradox are supported may depend on analytic method.Conclusions: Finding suggest that the benefits of self‐stigma reduction may be constrained by insight.