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Abstract Objective Evidence suggests that social skills training (SST) is an efficacious intervention for negative symptoms in psychosis, whereas evidence of efficacy in other psychosis symptom domains is limited. The current article reports a comprehensive meta-analytic review of the evidence for SST across relevant outcome measures, control comparisons, and follow-up assessments. The secondary aim of this study was to identify and investigate the efficacy of SST subtypes. Methods A systematic literature search identified 27 randomized controlled trials including N = 1437 participants. Trials assessing SST against active controls, treatment-as-usual (TAU), and waiting list control were included. Risk of bias was assessed using the Cochrane risk of bias assessment tool. A series of 70 meta-analytic comparisons provided effect sizes in Hedges’ g. Heterogeneity and publication bias were assessed. Results SST demonstrated superiority over TAU (g = 0.3), active controls (g = 0.2–0.3), and comparators pooled (g = 0.2–0.3) for negative symptoms, and over TAU (g = 0.4) and comparators pooled (g = 0.3) for general psychopathology. Superiority was indicated in a proportion of comparisons for all symptoms pooled and social outcome measures. SST subtype comparisons were underpowered, although social-cognitive approaches demonstrated superiority vs comparators pooled. SST treatment effects were maintained at proportion of follow-up comparisons. Conclusions SST demonstrates a magnitude of effect for negative symptoms similar to those commonly reported for cognitive-behavioral therapy (CBT) for positive symptoms, although unlike CBT, SST is not routinely recommended in treatment guidelines for psychological intervention. SST may have potential for wider implementation. Further stringent effectiveness research alongside wider pilot implementation of SST in community mental health teams is warranted.

Background Post-deinstitutionalisation, mental health supported accommodation services have been implemented widely. The available research evidence is heterogeneous in nature and resistant to synthesis attempts, leaving researchers and policy makers with no clear summary what works and for whom. In this context, we undertook a comprehensive systematic review of quantitative studies in order to synthesise the current evidence on mental health and psychosocial outcomes for individuals residing in mental health supported accommodation services. Methods Using a combination of electronic database searches, hand searches, forward-backward snowballing and article recommendations from an expert panel, 115 papers were identified for review. Data extraction and quality assessments were conducted, and 33 articles were excluded due to low quality, leaving 82 papers in the final review. Variation in terminology and service characteristics made the comparison of service models unfeasible. As such, findings were presented according to the following sub-groups: ‘Homeless’, ‘Deinstitutionalisation’ and ‘General Severe Mental Illness (SMI)’. Results Results were mixed, reflecting the heterogeneity of the supported accommodation literature, in terms of research quality, experimental design, population, service types and outcomes assessed. There is some evidence that supported accommodation is effective across a range of psychosocial outcomes. The most robust evidence supports the effectiveness of the permanent supported accommodation model for homeless SMI in generating improvements in housing retention and stability, and appropriate use of clinical services over time, and for other forms of supported accommodation for deinstitutionalised populations in reducing hospitalisation rates and improving appropriate service use. The evidence base for general SMI populations is less developed, and requires further research. Conclusions A lack of high-quality experimental studies, definitional inconsistency and poor reporting continue to stymie our ability to identify effective supported accommodation models and practices. The authors recommend improved reporting standards and the prioritisation of experimental studies that compare outcomes across different service models.

To describe the profile of individuals with depression who received assistance at CAPS in Brazil between 2013 and 2019, focusing on their clinical and demographic characteristics, and to calculate the estimated coverage of CAPS across the national territory and its constituent federal units. Descriptive, ecological, time-series study with secondary data from national databases, referring to care provided at CAPS in the country for adults aged 18 years or over-diagnosed with depression (F32-32.9 and F33-F33.9). The estimated coverage of CAPS was calculated for 2013 and 2019 using registered and active services. There was a 107% increase in the number of patients with depression receiving treatment at CAPS between 2013 and 2019. Women accounted for 77% of the patients, with the majority falling within the age range of 41 to 61years (49%). The predominant racial demographics were white (38%) and brown (34%). The diagnosis of depressive episodes was prevalent among 65% of the patients, and individual care was administrated to 75% of them. The presumed CAPS coverage was 71% in 2013 and increased to 87% in 2019 nationwide, although significant discrepancies were observed among different states. Progress was evident in the implementation of CAPS across Brazil during the period spanning 2013 to 2019. Nonetheless, disparities persist among the federative units, and there remains an underutilization of group and family care within CAPS services.

The Psychosocial Rehabilitation Project (PRP) is a tool designed to structure and organize mental health care, guided by the theoretical and practical principles of Psychosocial Rehabilitation (PR). This article aims to identify the initial requirements for the prototyping of a “Psychosocial Rehabilitation Project App”. To achieve this, an integrative review was conducted with the research question: what initial requirements are important to compose the prototype of the “Psychosocial Rehabilitation Project App” in mental health? In the search process, 834 articles were identified and exported to the online systematic review application Rayyan QCRI, resulting in 36 eligible articles for this study, along with one app. The reading of this material allowed the elicitation of three themes: privacy and data protection policy; design; and software and programming. The prototyping of the “Psychosocial Rehabilitation Project App” should prioritize data security and protection, simplicity in design, and the integration of technological resources that facilitate the management, construction, monitoring, and evaluation of psychosocial rehabilitation projects by mental health professionals.

The integration of artificial intelligence (AI) technologies into physical and mental rehabilitation has the potential to significantly transform these fields. AI innovations, including machine learning algorithms, natural language processing, and computer vision, offer occupational therapists advanced tools to improve care quality. These technologies facilitate more precise assessments, the development of tailored intervention plans, more efficient treatment delivery, and enhanced outcome evaluation. This review explores the integration of AI across various aspects of rehabilitation, providing a thorough examination of recent advancements and current applications. It highlights how AI applications, such as natural language processing, computer vision, virtual reality, machine learning, and robotics, are shaping the future of physical and mental recovery in occupational therapy.

AbstractOpioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality—notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.

No breakthrough has been made in dementia research to find a cure in the last century (Selkoe, 2012), but a great deal of progress has been made in the description of pathology. The damage caused by this multifaceted “disease” has been described in terms of its physical, neuropsychological, and social manifestations at an individual level but also its societal impact at large, often in financial terms.

Background In the UK, inpatient psychiatric rehabilitation services for complex psychosis aim to provide recovery-orientated treatment to patients, with the goal of supporting sustained stepdown into community living. The extent to which rehabilitation services uphold this recovery orientation is associated with better outcomes. However, few studies have been able to ascertain what promotes or prevents recovery orientation in inpatient settings. Methods We conducted an ethnographic study of treatment on a National Health Service (NHS) psychiatric rehabilitation ward in London over six months during August 2022-February 2023. Data were collected through participant observation and semi-structured interviews with 9 patients and 14 staff members. Fieldnotes and interview transcripts were analysed using situational analysis. Results Our analysis highlights the importance of what we term ‘relational engagement’ between staff and patients to nurture and sustain recovery-orientated treatment. This relational engagement was embodied through small acts of genuine human connection grounded in mutual acceptance and affective bonding; close attention to detail that communicated curiosity and respect; and recognition, appreciation, and encouragement of the slow and gradual progress that characterises recovery in complex psychosis. Yet, this relational engagement was often limited or foreclosed by the social environment of the ward and the wider institutional context. Limiting elements included the dominance of hospital logics geared towards high-throughput acute treatment and risk management; the presence of audit culture that led to a level of standardisation curtailing more genuine human connection; and staff demoralisation driven by events on and off the ward, including system-wide crises and more localised conflicts and disturbances. Some of these conflicts involved discrimination, most prominently anti-Black racism and homophobia, reflecting wider structural inequalities that characterise inpatient psychiatric populations and the healthcare workforce. Conclusion Relationships, often under-prioritised in mental health services, were a key cornerstone of recovery-orientated treatment on a psychiatric rehabilitation ward. The shaping of therapeutic relationships amounted to an active process of relational engagement, which may be afforded or constrained by complex social elements requiring careful consideration in inpatient psychiatry. These social elements go beyond more surface-level factors such as staff training, knowledge, or attitudes and may require structural and system-level interventions.

Despite recent advances in the development and provision of mental health and psychosocial support (MHPSS) in humanitarian settings, inadequate supervision remains a significant barrier to successful implementation. The present study sought to incorporate broad stakeholder engagement as part of the first phase of development of a new Integrated Model for Supervision (IMS) for use within MHPSS and protection services in humanitarian emergencies. Semi-structured interviews were conducted with 26 global mental health professionals. Data was analysed thematically, using a combination of inductive and deductive methods. Codes and themes were validated through co-author cross-checks and through a webinar with an expert advisory group. Results reinforce the importance of effective supervision to enhance the quality of interventions and to protect supervisees' wellbeing. Participants generally agreed that regular, supportive supervision on a one-to-one basis and as a separate system from line management, is the ideal format. The interviews highlight a need for guidance in specific areas, such as monitoring and evaluation, and navigating power imbalances in the supervisory relationship. Several approaches to supervision were described, including some solutions for use in low-resource situations, such as group, peer-to-peer or remote supervision. An integrated model for supervision (IMS) should offer a unified framework encompassing a definition of supervision, consolidation of best practice, and goals and guidance for the supervisory process.