Provision of mental health care to healthcare workers during COVID-19: A call for the practice of vulnerability

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,...

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: 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.

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.

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.

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.

In a deinstitutionalised mental health care system, those with mental illness require complex, multidisciplinary and intersectoral care at the primary or community service setting. This paper describes an Evidence Map of different strategies to strengthen the provision of mental health care at the primary health care (PHC) setting, the quality of the evidence, and knowledge gaps. Electronic and reference searching yielded 2666 articles of which 306 qualified for data extraction. A systematic review methodology identified nine different strategies that strengthen the provision of mental healthcare and these strategies are mapped in line with the outcomes they affect. The top three strategies that were reported the most, included strategies to empower families, carers and patients; integration of care or collaborative interventions; and e-health interventions. The least reported strategy was task shifting. The Evidence Map further shows the amount and quality of evidence supporting each of the listed strategies, and this helps to inform policy design and research priorities around mental health. This is the first systematic Evidence Map to show the different strategies that strengthen the provision of mental healthcare at PHC setting and the impact these strategies have on patient, hospital and societal level indicators.

Objective: This study examined ethnic disparities in antipsychotic therapy in a population with significant Asian representation. Methods: Using a cross-sectional retrospective study design, self-reported ethnicity data pooled from three cycles of the Canadian Community Health Survey were linked to 2005 administrative data on physician, hospital, and pharmaceutical use in British Columbia, Canada. Logistic regression was used to model the association between ethnicity and the likelihood of filling one or more prescriptions for any antipsychotic, with controls for sex, age, residence, immigrant status, income, health status, and diagnoses of schizophrenia, bipolar disorder, depression, and dementia. Results: Of the 27,658 individuals in the sample, 2.2% filled at least one antipsychotic prescription. The proportion varied across ethnic groups: Chinese, 1.0%; other Asians, 1.2%; whites, 2.3%; nonwhite non-Asians, 2.8%; and mixed ethnicity, 4.3%. After adjustment for patient characteristics and diagnoses of schizophrenia and bipolar disorder, the likelihood of filling a prescription was found to be lower among Chinese (odds ratio [OR]=.47, 95% confidence interval [CI]=.24–.90) and higher among persons of mixed ethnicity (OR=3.19, CI=1.49–6.83). Further adjustment for depression and dementia diagnoses did not significantly change the ORs for the Chinese (OR=.49, CI=.25–.98) and the mixed ethnic groups (OR=2.97, CI=1.30–6.80). Conclusions: Consistent with the existing literature on ethnic disparities in antipsychotic therapy, the study found evidence of persistent disparities in a population that has a significant number of Asians. Further studies should be done to identify possible causes of these disparities and to identify potential interventions that may reduce or eliminate them. (Psychiatric Services 62:1026–1031, 2011)

Mental health care for US veterans heavily criticised

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV

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.

Confidence in identifying different diagnostic categories of mental disorders by general health workers who provide the bulk of Papua New Guinea's (PNG) mental health care is vital for the country's provision of mental health care. Making a psychiatric diagnosis is complicated by PNG's diverse culture and estimated 800 distinct languages. These cultural-linguistic factors influence help-seeking behaviour and continued use of traditional treatment despite the introduction of western approaches to mental health care. The aim of this study was to determine the confidence of health workers in identifying and diagnosing different categories of mental health problems in this complex environment. A sample of 209 Papua New Guinea health workers from four geographic regions completed a questionnaire that assessed background levels of training and confidence in diagnosing a range of modern and culture specific diagnoses. Overall, respondents reported relatively little prior mental health training. Consistent with this were the relatively low levels of confidence for culture specific diagnoses (e.g. sorcery), but significantly higher levels of confidence with modern diagnoses (e.g. depression). The implications of the findings for training and provision of mental health care are discussed.

The provision of mental health care to older Americans poses a unique set of challenges to service providers. Barriers to the provision of care exist at both system and individual levels. Changes in political ideology from the Reagan through the Clinton administrations brought spending cuts and increasing uncertainty about the future of social welfare programs. Faced with frequent funding changes at the federal level, state and local governments must plan services in a framework of uncertainty. This uncertain political atmosphere puts the provision of mental health care to older persons in jeopardy. Medicare reimbursement rates for mental health care are low—about one half the usual and

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