Psychosocial adaptation following spinal cord injury: Perspectives of people with lived experience.

Mental health care among marginalized populations in the United States

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

We have read "The challenge of spinal cord injury care in the developing world" 1 by Burns and O'Connell with interest.They have presented an excellent review of the Spinal Cord Injury (SCI) care in the developing world.Based on our experiences in the largest rehabilitation institute of Pakistan, we offer additional comments and perspectives, which we believe also hold true for the South Asian region in general.

The purpose of this study was to determine sleep quality and presence of sleep disorders in participants with spinal cord injury (SCI). A web-based survey, available online from February 2011 to July 2013, using validated sleep questionnaires, advertised via the internet and locally through SCI consumer organizations in the United States, Australia, New Zealand, and Canada, was designed to evaluate sleep in adults with self-reported SCI. Demographic characteristics and medical history were obtained from participant self-report. In our study population, 70% of the 304 participants were male with a mean age of 45 ± 13 years. The mean duration of injury was 16 ± 12 years. Cervical injuries were reported by 49% and thoracic injuries noted in 40% of participants. Increased sleep apnea risk was noted in 31% of participants, with 66% reporting snoring. Insomnia symptoms were reported by 54% of the respondents. Almost 40% of participants ranked their sleep quality as "fairly bad" to "very bad" in the previous month, 29% reported "often" or "almost always" waking up because of pain, and 22% had difficulty falling asleep because of leg cramps. In the past year, 27% of the respondents reported daily uncomfortable leg sensations and 28% found these leg symptoms to be "moderately to extremely distressing." This study increases the awareness that insomnia, sleep apnea, and poor sleep quality are common in individuals with chronic SCI; often coexisting. There is a need for increased screening for sleep problems by healthcare providers taking care of individuals living with SCI.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Mental Health After Spinal Cord Injury: Findings from Focus Groups with People with SCI

A Global Call for Action to Prioritize Healthcare Worker Suicide Prevention During the COVID-19 Pandemic and Beyond.

Physiological analysis reveals that during voluntary contraction Ia afferent input have a lesser facilitatory effect on motor neurons in humans with chronic incomplete spinal cord injury compared with control subjects.

Editor's evaluation: Altered regulation of Ia afferent input during voluntary contraction in humans with spinal cord injury

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

COVID-19 disrupted services received by persons with spinal cord injury (SCI) worldwide. The International Disability Alliance declared the need for a disability-inclusive response to the COVID-19 crisis, as decreased access to health care services for individuals living with varying levels of function was unacceptable. As a result, an SCI community in Canada created a novel webinar-based strategy aimed at improving access to self-management information for people living with SCI and other stakeholders. However, although telehealth practices have previously been used effectively in SCI management and rehabilitation, little to no scholarship has investigated the outcomes of implementing a webinar-based telehealth strategy in this population. This study aims to understand the outcomes of implementing the webinar series. Specifically, the authors aimed to determine the reach of the series; understand its impact on social connectedness, perceptions of disability, and overall quality of interactions among persons with SCI, their families, service providers, and the public at large; and explore the long-term sustainability of the initiative. The authors implemented a community-based participatory strategy to define a convergent mixed methods design to triangulate qualitative and quantitative data collected simultaneously. Quantitative methods included pop-up questions administered during the live webinars, surveys administered following webinars, and an analysis of YouTube analytics. Qualitative methods included semistructured interviews with persons with SCI and health care providers who attended at least one webinar. The results were integrated, following methods adapted from Creswell and Clark. A total of 234 individuals attended at least 1 of the 6 webinars that took place during the 6-month study period. In total, 13.2% (31/234) of the participants completed the postwebinar survey, and 23% (7/31) participated in the semistructured interviews. The reach of the webinar series was mainly to persons with SCI, followed by health professionals, with most of them living in urban areas. The topics sexuality and research were the most viewed on YouTube. The knowledge disseminated during the webinars was mainly perceived as valid and useful, related to the fact that the presentation format involved people with lived experience and clinical experts. The webinars did not necessarily help build a new extended community of people involved in SCI but helped strengthen the existing community of people with SCI in Alberta. The webinar positively influenced the perceptions of normality and disability regarding people with SCI. The webinar format was perceived as highly usable and accessible. The webinar series was associated with improved participant knowledge of what is possible to achieve after an SCI and their perceptions of disability. The long-term implementation of this initiative is feasible, but further considerations to increase its reach to rural areas and ensure the integration of diverse individuals should be taken.

Objectives: Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction.Design: Cross-sectional.Setting: A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center.Participants/Methods: Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained.Results: Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life.Conclusions: Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.

"Spinal Cord Injuries as a Result of Earthquakes: Lessons From Iran and Pakistan." The Journal of Spinal Cord Medicine, 30(4), pp. 367–368

National health strategies are integral in defining the vision and strategic direction for ensuring the health of a population or for a specific health area. To facilitate a national coordinated approach in spinal cord injury (SCI) research and care in Canada, Praxis Spinal Cord Institute, with support from national experts and funding from the Government of Canada, developed a national strategy to advance SCI care, health, and wellness based on previous SCI strategic documents. This paper describes the development process of the SCI Care for Canada: A Framework for Strategy and Action. Specifically, it covers the process of building on historical and existing work of SCI in Canada through a thorough review of literature to inform community consultations and co-creation design. Furthermore, this paper describes planning for communication, dissemination, and evaluation. The SCI Care Strategic Framework promotes an updated common understanding of the goals and vision of the SCI community, as well as strengths and priorities within the SCI system regarding care, health, and wellness. Additionally, it supports the coordination and scaling up of SCI advancements to make a sustainable impact nationwide focusing on the needs of people living with SCI.

Background Mental health peer support has grown significantly worldwide within the last three decades. As with other nations, Aotearoa New Zealand is currently in the process of expanding the peer support workforce within its mental health system. This is a promising development because peer supporters have the ability to make unique epistemic contributions to service delivery due to their distinct lived experience epistemologies and practices. Indeed, policy documents tend to charactertise the potential of peer support as transformative. However, literature has indicated that peer supporters face challenges when working within traditional mental health spaces. These include distrust from other mental health professionals, struggling against a dominant biomedical framing of mental distress, feeling relegated to an assistant clinician role, and ambiguities concerning role definition and scope. In this thesis I explore whether and how these challenges may contribute to peer supporters experiencing epistemic injustice. Aim I sought to explore how peer supporters experience and understand the epistemic conditions within the mental health system and what causal mechanisms may contribute to epistemic injustice in this context. As part of this investigation, I aimed to identify key factors that can aid in protecting peer support’s epistemic qualities when situated within mainstream mental health services. Methods I took a critical realist informed, contextual epistemic injustice approach to this research. The main phase of the study comprised 28 interviews, with 14 peer supporters and 14 clinicians. Following this, I drafted themes and a preliminary framework for peer support epistemic justice and consulted with six peer supporters to review the framework and develop it further. I analysed data using a critical realist adaptation of thematic analysis that considered epistemic injustice within each domain of critical realism’s stratified conception of reality. These findings were synthesised following consultation in order to create a framework that may facilitate peer support epistemic justice within Aotearoa New Zealand’s mental health system. Findings Peer supporters are well positioned to aid in system and service transformation. Their knowledge is derived from lived experience of mental distress and mental health services, resulting in a unique standpoint to provide compelling and actionable insights. Peer support’s lineage is partly within activist grassroots movements which held mainstream mental health systems to account. Elements of this adversarial relationship continue, with peer supporters frequently perceived as a counterbalancing force to clinical orientated services. The transformative discourse associated with peer supporters in policy suggests that peer supporters possess knowledge that is compelling, distinctive and disruptive to existing systems. Peer supporters operate within an epistemically precarious position in Aotearoa New Zealand. They are expected to transform the mental health system and challenge clinical culture within mental health services – while being paid less than other professions and lacking the usual markers of legitimacy that denote epistemic authority. Peer supporters are near the bottom of a systemic knowledge hierarchy which enshrines a medical episteme as the highest form of mental health knowledge. As a practice and knowledge system, peer support is at risk of losing its distinctive features and falling into a ‘mini clinician’ role. Being explicitly ‘out’ as having had mental health challenges can lead to stigmatising responses from mental health providers and further devalue how peer support knowledge is received. The epistemic agency of peer supporters can be protected by developing robust peer support leadership positions, orientating clinicians to the peer support’s role and historical context and building up national-scale advocacy and representation. The move to integrate peer supporters into mental health services must be paired with a sustained effort to ensure their knowledge system and epistemic agency are protected. Conclusions Peer support knowledge systems can positively impact Aotearoa New Zealand’s mental health system and mental health systems around the globe. As a workforce that straddles the line between experiential knowledge and professional training, peer supporters are particularly equipped to strengthen the voice of tāngata whaiora (service users) who themselves are at a marked risk of facing epistemic injustice. However, actualising their potential will require attending to the structural and relational conditions within the system which inhibit flourishing of peer supporter knowledge. This research is among the first to investigate epistemic injustice within a peer support context. Peer support is positioned by policy as a force for transformation but this transformative capability rests upon a move towards epistemic justice.