Establishing a Relationship with a Mental Healthcare Provider

IntroductionSocial work is a key member of interprofessional primary healthcare teams and foundational to primary healthcare reforms that aim to improve the provision of mental healthcare. Little is known, however,...

Objective: The aim was to determine the prevalence of Axis-1 mental disorders and healthcare provision in Zambian correctional facilities. Purpose: To determine the prevalence rate of Axis-1 disorders, mental health problems and access to mental healthcare provision in Zambian correctional facilities. Methods: 240 inmates from three different types of correctional facilities namely: Two maximum security facilities, one medium and minimum correction facilities respectively. 240 inmates were interviewed using the Mini Neuro-psychiatric Interview, Warwick-Edinburgh Mental Well-being scale and demographic questionnaire. Results: The prevalence was 71% for current, past and lifetime Axis-1 disorders. However, for current Axis-1 disorders, the prevalence rate was 46.2%. Combined (current and past) Axis-1 disorders prevalence was 63.3%. major depressive episode current was the most prevalent 47, 19.6%, psychotic disorder current 38, 15.8%, psychotic disorder lifetime 18, 7.5%. Major depressive episode past 17, 7%, substance dependency current and Post-traumatic disorder at (14) 5.8%, Manic episode current 5, 2.1% and the rest below 2% respectively. With WEMWBS mean at 50.7, when the mean scores from the three correctional facilities were statistically compared, results indicated that inmates from minimum (50.7) showed good and stable mental well-being compared to medium and maximum correctional facilities whose inmates recorded poor mental well-being. Conclusion: There is high prevalence of Axis-1 disorders in Zambian correctional facilities. The majority of these inmates remain undiagnosed, untreated and stigmatised. Inmates in Zambian correctional facilities are not screened for mental health problems and disorders at point of entry, during incarceration and exit point. Mental healthcare provision is almost nonexistence across all the correctional facilities. There is urgent need for the line ministries and other stake holders to refocus their attention to greater awareness and provision of mental health services focusing on holistic interventions that address mental health and disorders in Zambian correctional facilities.

BackgroundPeople with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa.MethodsQualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis.ResultsParticipants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide.ConclusionsTraining mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.

The present review provides an overview of key issues and concepts on the provision of mental healthcare to refugees with mental health conditions. Several barriers to mental healthcare for refugees have been described, and principles for good mental care in this group have been framed. Evidence for specific interventions for refugees is available for trauma-related mental health problems. The best evidence is available for psychosocial interventions for the treatment of posttraumatic stress disorder. The worldwide increase in the number of refugees and the substantial burden of psychological distress and mental health problems associated with this condition has led to an increased research and policy interest for optimizing the provision of effective mental healthcare. To date, with the exception of trauma-related conditions, there is almost no evidence on the efficacy of psychosocial interventions for anxiety and depressive conditions, and there is no information on how mental healthcare should be embedded into existing health and social care services. Existing research and implementation activities will hopefully contribute to better characterize the effective components and elements of mental healthcare programmes for refugees.

A qualitative study of community pharmacists in New Zealand: mental health literacy and the barriers and facilitators to providing and receiving mental healthcare in community pharmacies

Vicarious trauma in mental health care providers

BackgroundThere is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers’ willingness, comfort, and skills to adequately provide care to patients who present with mental health issues.ObjectiveThe aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions.MethodsA needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved.ResultsCaregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician’s office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son’s or daughter’s mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care.ConclusionsRobust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other’s perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives.

To identify barriers and enablers to the provision of mental health care by Primary Health Organisations (PHOs) in the northern region. Information was generated from structured interviews with 22 of the 25 PHOs and the four District Health Boards (DHBs) in the northern region. Of the 22 PHOs who participated in the study, 17 had at least one specific mental health initiative; others had up to five initiatives. PHOs that were funded to provide one of the 41 Ministry of Health mental health pilot projects had more mental health initiatives in place. Barriers and enablers to providing mental health care occurred in areas such as workforce capacity, funding, infrastructure, and limited interest in transfer of care from secondary to primary care. Barriers to providing mental health care within the primary sector include stigma, lack of training, communication between sectors, funding and perceptions of sector roles. Factors which enable provision of mental health care are availability of training, good communication between sectors, use of available and new funding mechanisms and community involvement. Further research at the practice and practitioner level is necessary to fully understand development of mental health care within the primary care sector.

Objective: This study explored mental health care providers’ experiences of preventing suicide in people with substance use disorders and their perceptions of factors related to clinical practice that contributed to these experiences.Methods: In-depth, semistructured interviews were conducted with 18 mental health care providers working in South Africa. Thematic analysis was used to analyse the data inductively with Atlas.ti software.Results: Participants described feeling hopeless, helpless, powerless and guilty and needed to debrief from their experiences of preventing suicide. They perceived their experiences to be related to the difficulties of treating substance use disorders, the difficulties of assessing and managing suicide risk and how treating substance use might increase suicide risk.Conclusions: The ways in which mental health care providers think about suicide and make sense of their experiences affects their perceived abilities to prevent suicide. Educating mental health care providers to transcend the limitations of risk factor approaches to suicide prevention and utilise evidence-based strategies for treating substance use disorders and associated problems, may be important to empower them and make them feel competent in suicide prevention. Empowering people with substance use disorders may help prevent suicide and may require collaboration between mental health care providers and allied professionals.

Mental health care provision is increasingly recognized as necessary in the treatment of craniofacial conditions and an essential part of multidisciplinary teams. European Reference Networks (ERNs) are networks involving hospitals recognized as expert centers for specific rare conditions. The current study investigated the extent and organization of mental health care services within the ERN for rare and/or complex craniofacial anomalies and ear, nose, and throat disorders (ERN CRANIO). An online survey was sent to all full and affiliated member centers involved in the treatment of craniofacial conditions (41 centers, 19 countries). Respondents were Mental Health Care Providers (MHPs) and/or Team Coordinators (TCs). The response rate was 90.2%. Most centers (86.5%) had a MHP connected to the team, 46.9% of those in a full-time position. The accessibility of the MHP did not seem to be related to a center's number of new patients per year. Patient groups were children/adolescents (83.8%), caregivers (73.0%), or adults (21.6%). A quarter (25.0%) offered follow-ups across the lifespan. MHPs provided consultations and/or interventions (31.9%), cognitive and/or developmental assessments (18.7%), support during hospitalizations (16.9%), and attended multidisciplinary meetings about/with patients (13.6%). Financial barriers were mentioned by all centers without access to an MHP. Results indicate that most ERN CRANIO centers have an MHP connected to their team. Mental health services, however, vary both in terms of the MHP's availability, and the type of service offered. Future studies should evaluate how psychological services should be offered and include the perspectives of families/patients with craniofacial conditions.

Background: Tobacco-related morbidity and mortality is high among people with mental illnesses (PMI); yet tobacco treatment (TT) is often not provided by mental health care providers (MHPs). Studies that examine barriers to TT for people with MI are critical in addressing this disparity.Aims: To determine factors associated with MHPs’ opinions of, self-efficacy in, barriers to and training needs for providing TT by job role.Methods: 205 MHPs in a psychiatric facility were surveyed using a standardized questionnaire on demographics and opinions, self-efficacy, barriers and needs to providing TT. Descriptive and multivariate regression analyses examined factors associated with the main outcomes.Results: MHP’s gave high ratings to both the appropriateness of delivering evidence-based TT and their confidence in providing TT medications. In regards to perceived barriers to providing TT, MHP’s further endorsed that patients should be provided nicotine replacement therapy and be motivated to engage in TT. Key needs were for training in cessation counseling, cessation materials and community support for TT.Conclusions: Based on our findings, future studies are needed to address providers’ biases and concerns, eliminate system-barriers and determine effective provider training. Moreover, these findings may guide research, practice and policies toward enhancing TT in PMI.

This cross-sectional study examined the relationships among healthcare provider trust, social identity concordance (i.e. race, sex/gender, sexual orientation), internalized racism, everyday discrimination, and healthcare discrimination across four healthcare settings: dental, medical, mental, and vision. The study sample included Black American adults (Mean age = 37.68). Findings showed that, after accounting for demographic factors and identity concordance: (a) race concordance did not relate to provider trust, (b) sex/gender concordance was positively linked to trust in medical, mental, and vision healthcare providers, (c) sexual orientation concordance was associated with greater trust in dental and mental healthcare providers, (d) internalized racism and healthcare discrimination were associated with lower provider trust in all settings, and (e) everyday discrimination was negatively linked to trust in dental providers only. These results suggest identity concordance alone is insufficient in fostering trust in healthcare providers, highlighting the need for further research on addressing internalized and systemic racism.

Many health care organizations are giving feedback to mental health care providers about their performance on quality indicators. Mental health care providers may be more likely to respond to this feedback if they believe the indicators are meaningful and within their "sphere of influence." The authors surveyed frontline mental health care providers to elicit their perceptions of widely used indicators for quality monitoring in mental health services. The survey was distributed to a stratified, random sample of 1,094 eligible mental health care providers at 52 Department of Veterans Affairs facilities; 684 (63%) returned the survey. The survey elicited perceptions of 21 widely used indicators in five quality domains (access, utilization, satisfaction, process, and outcomes). The data were analyzed with descriptive and multivariate methods. Most mental health care providers (65%) felt that feedback about these widely used indicators would be valuable in efforts to improve care; however, only 38% felt able to influence performance related to these monitors and just 13% were willing to accept incentives/risk for their performance. Providers were most positive about satisfaction monitors and preferentially included satisfaction, access, and process monitors in performance sets to measure overall quality. Despite providers' relatively positive views of monitors, 41% felt that monitoring programs did not assist them in improving care. Providers cited numerous barriers to improving care processes. Mental health care providers may be more receptive to monitoring efforts if satisfaction, access, and process monitors are emphasized. However, providers' views of monitoring programs appear to be less affected by concerns about specific monitors than by concerns about the accuracy of quality measurement and barriers to changing care processes.

Background: Burnout, especially emotional exhaustion, is common among mental healthcare providers (MHP). It is caused by exposure to prolonged stress related job conditions, such as secondary traumatisation. Social support is a protective factor for developing emotional exhaustion. In addition, higher levels of social support are associated with lower levels of secondary traumatisation. However, it is unclear how social support and secondary traumatisation are related. Social support may be a protective factor for developing secondary traumatisation, as it is for emotional exhaustion. On the other hand, MHP who suffer more from secondary traumatisation might experience less social support, for example because they fear stigmatisation. This study examined whether social support mediates the relationship between secondary traumatisation and emotional exhaustion. Further, it is explored whether the relation between secondary traumatisation and social support is moderated by profession (physicians, psychologists and case managers). Method: In total, 593 MHP participated in this cross-sectional study. Participants completed a questionnaire including demographic characteristics, secondary traumatisation, emotional exhaustion, and social support. Results: It was shown that no MHP experience high levels of secondary traumatisation and relatively few experience high levels of emotional exhaustion, while they do experience much social support. Furthermore, as hypothesized, it was found that the relationship between secondary traumatisation and emotional exhaustion is partially mediated by social support. Finally, no moderation effect of profession was found. Conclusion: These results imply that MHP have access to social support and make use of it, preventing emotional exhaustion. Mental healthcare organisations should maintain these resources for social support to prevent emotional exhaustion. MHP who are less inclined to seek social support should receive extra attention, as should MHP who are more at risk of secondary traumatisation. Even though MHP experience the availability of social support, still 25% of the MHP do experience emotional exhaustion. Future research should examine which factors for this group contribute to the development of emotional exhaustion so that appropriate measures can be taken.

Efforts to increase the provision of mental health care for prisoners have been met with criticism suggesting that mental health treatment in prison is likely to serve institutional rather than inmates’ interests. In this context, the present study seeks to explore the use of various forms of mental health treatment with mentally ill offenders as a function of diagnosis, problem behavior in the institution, and gender among a sample of 513 Canadian inmates. The data was obtained from a review of institutional files as well as face-to-face interviews with inmates. Associations between the main variables were examined using multivariate logit analysis. Results indicate that the provision of mental health care in Canadian provincial institutions is still minimal. Furthermore, women inmates are significantly more likely to receive mental health services compared with their male counterparts. Psychiatrists appear to have a particularly important role in managing conduct problems in the institution. Finally, the presence of dysphoria or social withdrawal in inmates is associated with an increased probability of being provided with individual or group therapy. The results suggest that factors other than psychiatric symptomatology, such as gender and institutional misconduct, may influence the provision of mental health care services in correctional settings.