Mental illnesses during pregnancy and after birth (perinatal period) affect one in five mothers and one in ten fathers. They can have adverse implications for child health and development and come with substantial economic costs. Many countries have developed integrated care models. We aim to summarize the international care model recommendations and contrast them with the current situation in Austria.

We conducted a scoping review of guidelines and recommendations for perinatal and infant mental health care (PIMHC) models and synthesized them into a best-practice model. The model overview targets prevention, early identification, and care of perinatal mental illness (PMI), as well as professional groups involved. We identified available Austrian PIMHC services via online search and expert consultation, clustered them according to our international model structure, and visualized availability on a geographical map. Additionally, we analyzed the use of five core mental health benefits from health insurance data. We narratively contrasted international recommendations with the Austrian availability and use of services.

International recommendations suggest integrating primary prevention, systematic screening, and stepped care. After identifying a PMI, a care pathway needs to be defined, including diagnostic and coordinated needs-based care. For severe PMI, specialized services should be available and provided by trained psychiatrists and specialists, such as perinatal mental health midwives. In Austria, various services for different severity levels of PMI are available. However, large geographical variations and gaps exist regarding specialist services, such as mother–baby units. Specially trained health professionals are lacking. Still, almost one in five mothers claimed one of the defined mental health benefits during the perinatal period.

PIMHC in Austria currently does not follow best-practice recommendations. The main gaps are in providing guideline-based specialized care by trained professionals. Insurance-funded mental health service use during the perinatal period corresponds with international prevalence figures, although only a part of available services is included in the analysis. To ensure women receive high-quality care, PIMHC needs to be more prioritized.

Little is known about the determinants of community integration (i.e. recovery) for individuals with a history of homelessness, yet such information is essential to develop targeted interventions.

We recruited homeless Veterans with a history of psychotic disorders and evaluated four domains of correlates of community integration: perception, non-social cognition, social cognition, and motivation. Baseline assessments occurred after participants were engaged in supported housing services but before they received housing, and again after 12 months. Ninety-five homeless Veterans with a history of psychosis were assessed at baseline and 53 returned after 12 months. We examined both cross-sectional and longitudinal relationships with 12-month community integration.

The strongest longitudinal association was between a baseline motivational measure and social integration at 12 months. We also observed cross-sectional associations at baseline between motivational measures and community integration, including social, work, and independent living. Cross-lagged panel analyses did not suggest causal associations for the motivational measures. Correlations with perception and non-social cognition were weak. One social cognition measure showed a significant longitudinal correlation with independent living at 12 months that was significant for cross-lagged analysis, consistent with a causal relationship and potential treatment target.

The relatively selective associations for motivational measures differ from what is typically seen in psychosis, in which all domains are associated with community integration. These findings are presented along with a partner paper (Study 2) to compare findings from this study to an independent sample without a history of psychotic disorders to evaluate the consistency in findings regarding community integration across projects.

In an initial study (Study 1), we found that motivation predicted community integration (i.e. functional recovery) 12 months after receiving housing in formerly homeless Veterans with a psychotic disorder. The current study examined whether the same pattern would be found in a broader, more clinically diverse, homeless Veteran sample without psychosis.

We examined four categories of variables as potential predictors of community integration in non-psychotic Veterans: perception, non-social cognition, social cognition, and motivation at baseline (after participants were engaged in a permanent supported housing program but before receiving housing) and a 12-month follow-up. A total of 82 Veterans had a baseline assessment and 41 returned for testing after 12 months.

The strongest longitudinal association was between an interview-based measure of motivation (the motivation and pleasure subscale from the Clinical Assessment Interview for Negative Symptoms) at baseline and measures of social integration at 12 months. In addition, cross-lagged panel analyses were consistent with a causal influence of general psychiatric symptoms at baseline driving social integration at 12 months, and reduced expressiveness at baseline driving independent living at 12 months, but there were no significant causal associations with measures of motivation.

The findings from this study complement and reinforce those in Veterans with psychosis. Across these two studies, our findings suggest that motivational factors are associated at baseline and at 12 months and are particularly important for understanding and improving community integration in recently-housed Veterans across psychiatric diagnoses.