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Psychosocial, Cognitive, and Behaviour After Effects of Traumatic Brain Injury: Perspectives of Survivors and Caregivers in Ghana Abstract Traumatic brain injury remains a significant public health concern globally. Using a phenomenological design, 10 participants (5 survivors and 5 caregivers) were purposively recruited from the Surgical Outpatient Department of the 37 Military Hospital, Accra for the study. The purpose of this study was to describe and explore the psychosocial, cognitive, and behaviour issues of survivors and caregivers following traumatic brain injury (TBI) in Ghana. Credibility measures included an independent audit of the analysis by supervisors, multiple investigator triangulation (survivors and caregivers) and enquiry audit (field notes). The findings of the study revealed irritability, hyperactivity, anxiety and depression as the emotional impact of TBI on survivors. Also, TBI adversely affected caregivers because of the burden associated with caring for the survivor and the  related loss of function. It was further revealed that the availability of comprehensive rehabilitation services and return to pre-injury level will improve survivors’ quality of life. It was concluded that TBI impact is both immediate and long-term and requires a concerted effort from researchers and policymakers through the development of ongoing surveillance programmes and implementing effective evidence-based interventions. Recommendations were also discussed.

Treating Mentally Ill Offenders in an Inpatient Setting Abstract Adverse childhood experiences, such as abuse, neglect and household dysfunction have been linked to negative adult outcomes. These outcomes include psychiatric disorders, poor psychosocial functioning, homelessness, substance abuse and incarceration. Unfortunately, individuals with mental health problems may find themselves arrested for misdemeanors such as trespassing, alcohol and drug related charges, disorderly conduct or other less serious charges. If a person is determined to be psychiatrically unstable, they may be held in jail while waiting for a psychiatric evaluation, waiting for a hospital bed, or for transportation to a psychiatric hospital for treatment. Situations arise that in which a person’s sentence is completed, but the court determines that they are not ready to live in the community because of actions that occurred while incarcerated, or because of the charges that resulted in incarceration. These offenders are then released to a psychiatric hospital for treatment to prepare them for community reintegration. When this cohort is sent to an inpatient setting involuntarily it makes treatment very challenging. It is essential for community reintegration and decarceration that we gain an understanding of how to successfully treat mentally ill offenders when they are moved from a criminal justice setting into an alternate treatment setting involuntarily. This paper will consider difficulties that may arise and suggest treatment alternatives to reach this cohort when retained in an inpatient setting.

Eco-Friendly Holi Colors: Hospital Based ‘Income Generation Activity’ for Persons with Mental Health Challenges at a Quaternary Mental Health Care Facility in India Abstract Persons with mental health challenges have a felt need to earn an income but are constrained by opportunities. A hospital based income generation activity for making ‘Eco-friendly Holi colors’ was conceptualized with inter-sectoral collaboration to create opportunities for persons with mental health challenges, involve them as ‘stakeholders’ and distribute profits among them. Holi colors were chosen due to the novelty of product, ease of production and good profit margin. In this paper, we describe the need, process, experience, facilitators, challenges and key learnings in the selected income generation activity.

The Legitimacy of User Knowledge in Decision-Making Processes in Mental Health Care: An Analysis of Epistemic Injustice Abstract The experience-based knowledge of users is considered to provide vital input in shared decision making (SDM). However, mental health service users frequently express having negative experiences from meetings with providers, which are of an epistemic nature (e.g., being ignored or not regarded as credible). This study aimed to explore the barriers involved in legitimizing user knowledge in decision-making processes. Interview data from service users and providers were viewed from a theoretic framework of epistemic injustice. Abductive content analysis was conducted on data collected during a project to develop and implement SDM in mental health services. In describing obstacles to legitimize user knowledge, service users highlighted relational issues: being dependent, often dismissed and choosing to edit their testimonies. Service providers typically described workflow issues, users’ insufficient decision-making competence and users’ vulnerability to stress factors. The findings suggest that greater epistemic justice might be achieved by a SDM process in which the service user is engaged as a full partner in collaboration in various activities related to their care.

From the (Dis)comfort of One’s Own Home: Patients’ Experiences of Hospitalization After Discharge. A Qualitative Study of Lived Experience of Hospitalization from the Perspective of People with a Mental Health Disorder Abstract The aim of the study was to investigate the role of inpatient treatment in the recovery process and explore how patients view hospitalization when looking back after 3 months. The study was developed within a framework of user-involved research; all stages of the research process involved cooperation with service user coresearchers. Fourteen patients were recruited, all of whom had been in inpatient treatment for at least 3 weeks. The findings are based on analyses of interviews with the participants 3 months after discharge. Three key themes reflected the participants’ experiences when looking back at their hospitalization 3 months after being discharged: (i) A break from everything “out there”; (ii) A safety net to catch me if I fall; and (iii) From being looked after to taking responsibility for yourself. The transition from being an inpatient to returning home can be hard. Findings suggest that belonging to a social network plays an important role in recovery, and that this might be a meaningful focus during admission.

Impact of a Co-produced Initiative for Mental Health Programming at a Canadian Psychiatric Hospital Abstract There has been a call for a paradigm shift in mental health to be more recovery-oriented and include service users in the development and delivery of services. Although co-production has been linked with positive outcomes, more work is needed to understand this approach in Canada. The current study assessed the outcomes of a co-production initiative for service design and delivery. The data yielded positive outcomes—both for facilitators and group participants—in two broad areas: related to personal recovery and positive attitudes toward the organization. This study provides support for co-production in mental health programming and further elucidation of this approach for mental healthcare settings in Canada.

Counselors’ Knowledge and Attitudes of the Recovery Paradigm Abstract Counselors generally subscribe to a wellness or holistic paradigm; however, the recovery paradigm, with collaborative strategies and unique treatment planning, is a directed approach of mental health services that can allow counselors to help in the recovery process. Thus, the purpose of this quantitative study was to understand what factors contribute to counselors’ knowledge and attitudes of the recovery paradigm. Surveys were used to examine whether professional counselors’ years of experience, gender, professional setting, and licensure status correlate to their knowledge and attitudes as measured by the 4 subscales of the recovery knowledge inventory. The results of a multivariate multiple regression were not significant. However, the results of this study align with previous research outcomes indicating a need for counselors’ continued education and training on the recovery paradigm, which can impact consumers’ achievement of recovery goals through counselors’ improved knowledge and attitudes.

Emotional Support Animals in the United States: Emergent Guidelines for Mental Health Clinicians Abstract The role of Emotional Support Animals (ESAs) in facilitating mental health recovery is gaining increasing attention internationally. Within the United States, ESAs are companion animals without any special training, who are denoted in writing by a licensed mental health professional to be a therapeutic necessity for someone living with chronic mental health symptoms and who has a condition that meets the legal definition of a disability. ESAs are recognized within federal disability legislation, with limited rights to those who have ESAs as accommodations for their disabilities. The aim of this article is to present ESAs as a valid psychosocial rehabilitation intervention, consistent with the tenets of mental health recovery. Empirical literature is discussed, and a theoretical foundation is applied to explain the mechanism within the theory of change for how and why ESAs benefit people living with chronic mental health issues. To advance the current literature and practice, emergent best practices and guidelines for mental health clinicians for designating and documenting ESA need for clients who request such are provided.

Relationship Between Caregivers’ Burden of Schizophrenia Patient with Their Quality of Life in Indonesia Abstract This study aims to identify the relationship between caregiver burden of patients with schizophrenia and caregiver quality of life (QOL). A cross sectional study involving 222 caregivers patients with schizophrenia was conveniently recruited from the psychiatric clinic of a mental health hospital in Malang Indonesia. Caregiver Burden Inventory Scale and Schizophrenia Caregiver QOL was used to assess the level of burden and QOL among the caregivers respectively. Descriptive statistics was used to determine caregivers’ socio-demographic characteristic and the level of caregivers’ burden and QOL. Spearman Rho correlation test was conducted to determine the relationship of caregiver burden and caregiver QOL. About 59.6% of schizophrenia caregivers experienced moderate to severe level of burden. The results showed that there was a significant, strong and negative relationship between the caregiver burden and QOL (r = − 0.434, p < 0.001). Most of the participants reported emotional burden and moderate QOL especially psychological and physical QOL, well-being, relationships with friends, and material burden. The findings indicated the higher the caregiver burden, the lower the QOL experienced by family caregivers of individuals with schizophrenia. It is necessary to improve the mental health nursing services for schizophrenia caregivers by providing mental health counseling, and developing support groups for them.