PROJECT
Linking people with mental illness into evidence-based treatments
Assisting those with mental illness to find suitable treatment
For people with mental illness and comorbid alcohol and drug disorder, engagement in community rehabilitation is difficult with relapse commonly occurring.
Although an evidence base exists for treatment strategies that complement medication and family work for people with schizophrenia, it is difficult to engage them in additional community treatment programs.
This research project addresses the engagement issue with the development, implementation and testing of three programs designed to improve treatment engagement by providing the support required to link the patient in treatment to community treatment programs.
The project aims to improve long-term outcomes for people with mental illness and comorbid alcohol and drug disorders and schizophrenia, being treated at a Mental Health Unit, by supplementing family work and medication with voluntary linkage interventions based on evidence-based supported employment and community therapy.
The linkage interventions are designed to promote local service culture change and to overcome stigma and treatment engagement difficulties in mental illness and comorbid substance use disorder and schizophrenia.
The three interventions provide support in the areas of supported employment, substance use disorders and voice hallucinations.
Each intervention program is currently being tested in single-blind randomised controlled trials with treatment as usual or standard treatment.
The three interventions have been introduced as programs at the Mental Health Unit, Sir Charles Gairdner Hospital. These are:
- Supported Employment Trial: supports engagement to a local employment agency with good fidelity to the Individual Placement and Support approach to supported employment for people with schizophrenia.
- Substance Use Trial: involves best evidence therapeutic principles for patients with mental illness and comorbid alcohol and drug disorder for engagement with the patient’s preferred long-term community alcohol and drug treatment program.
- Voice Hallucination Trial: clinical psychologist aiming to engage the patient with schizophrenia and distressing auditory hallucinations to a clinical psychologist in the community by choice.
This project is run in collaboration with Sir Charles Gairdner Hospital Mental Health Service, the West Australian RANZCP Postgraduate Training Program, and the Freshstart Recovery Program.
PhD opportunities
- Voice Hallucination Study
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Normal treatment doesn't involve any individual time with a clinical psychologist on the mental health unit, which is proving difficult because either patients or family want them to see a psychologist on the unit, and therefore they can be withdrawn from the trial or are not allowed on the trial in the first place.
Some of the psychologists are in an ethical conflict about depriving patients with schizophrenia the opportunity to talk with them but still agree with the trial in principle.
These patients can go into a new Naturalistic Longitudinal Study using the same measures and blinded assessors as in the current trial. The PhD student would be required to gain ethics approval and conduct project management, including recruitment.
- Expanding on the Voice Hallucination Study
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This PhD opportunity involves expanding the three trials into other mental health units (MHUs) and proving any significant statistical difference between the treatment groups.
Based on recruitment over at least the last 10 months, at about one participant per month per trial, this will take eight more years for the Substance Use and Supported Employment Trials, and three years for the Voice Hallucination trial.
Expanding the trials will shorten the trial lengths and promote needed positive culture change in other MHUs more quickly. Expanding the Voice Hallucination trial would be relatively easy because clinical psychologists are posted to all MHUs.
Expanding the Supported Employment Trial is also straightforward because it would require training mental health nurses on the units in a simple positive to use six-month telephone support intervention.
The author has already piloted 15 patients with the intervention and the nursing feedback has been resoundingly positive, as well as trained five committed nurses for the current trial. The Substance Use Trial would be possible, but more difficult, because most of the Mental l Health Units except one other do not have alcohol and drug nurse clinicians to do the more time intensive intervention.
- Additional Supported Employment Studies
- This PhD opportunity involves developing and testing further interventions on MHUs and in the community to get people with Schizophrenia, who want to work, into supported employment. The PhD student would be required to evaluate what keeps people with Schizophrenia who want to work in supported employment for the long-term. They would also further evaluate the benefits of supported employment on physical and mental health.
- Additional Substance Use Studies
- The PhD student would be required to explore and measure the elements of community rehabilitation participants choose in the trial which stop relapse of substance use disorder in mental illness.