Who seeks help? Factors associated with utilisation of primary care mental health services in Singapore.

ObjectiveTo analyze factors associated with and predicting Mexican women seeking primary care mental health services (PCMHS) and provide suggestions to increase PCMHS utilization.MethodWe administered a questionnaire to (N = 456) female patients in Mexico City primary care clinics. We conducted chi-square analyses of seeking PCMHS and: socio-demographic variables, perceptions of and experiences with PCMHS. Our results and literature review guided our logistic regression model.ResultsWomen referred to a mental health provider (MHP; [OR] = 10.81, 95% CI = 3.59–32.51), whose coping mechanisms included talking to a MHP (OR = 5.53, CI = 2.10–14.53), whose primary worry is loneliness (OR = 8.15, CI = 1.20–55.10), and those who follow doctor’s orders; were more likely to seek PCMHS (OR = 0.28, CI = 0.09–0.92).ConclusionsPrimary care providers play a fundamental role in women’s decisions to seek PCMHS. Proper referrals to PCMHS should be encouraged.

Objectives: To identify a generic set of face valid quality indicators for primary care mental health services which reflect a multi-stakeholder perspective and can be used for facilitating quality improvement....

This article draws on an environmental scan and interviews with visible minority immigrants in a small urban Atlantic community to report on gaps and opportunities for improving access to information about primary mental health care services and barriers to utilization of these services. Information about services was limited and did not specifically address the complex health-related concerns of immigrants with diverse religious and cultural backgrounds. Accessing information about mental health care services was challenging for some visible minority immigrants because of physical and financial constraints and limited computer and language literacy. The major barriers to the utilization of primary mental health care services were lack of information, language and literacy issues, a mistrust of primary mental health care services, the stigma associated with mental illness, long wait times, lack of finances, and religious and cultural differences and insensitivity. A list of nine recommendations, which may be of interest to mental health decision-makers and service providers in small urban centers with limited ethno-cultural diversity, is provided.

Continued engagement with primary mental health services has been associated with the prevention of subsequent suicidal behaviour; however, there are few studies that identify determinants of treatment disengagement among those at risk of suicide in primary care settings. This study investigated determinants of treatment disengagement of those at risk of suicide who were referred to primary mental health care services in Western Sydney, Australia. This study used routinely collected data of those referred for suicide prevention services provided through primary mental health care services between July 2012 and June 2018. Associations between sociodemographic, diagnostic, referral- and service-level factors and treatment non-attendance and early treatment cessation were investigated using a series of multivariable generalised estimation equations. There were 1654 suicidal referrals for 1444 people during the study period. Those identified with a risk of suicide were less likely to never attend treatments (16.14% vs 19.77%), but were more likely to disengage earlier from subsequent service sessions (16.02% vs 12.41%), compared to those with no risk of suicide. A higher likelihood of non-attendance to any primary mental health care service sessions was associated with those aged 25-44, lower socioeconomic status, a presentation for substance use and a referral from acute care (either emergency department or hospital). Among those who attended an initial treatment session, younger age (18-24 years) and a longer waiting time for an initial follow-up appointment were associated with a higher likelihood of early treatment cessation from primary mental health care services. These findings can inform potential strategies in routine primary mental health care practice to improve treatment engagement among those at risk of suicidal behaviour. Youth-specific interventions, behavioural engagement strategies and prompt access to services are policy and service priorities.

With rapid growth and development in recent decades, the State of Qatar has been redefining strategies and policies towards building a world-class healthcare system. Mental health has emerged as a priority area for development. As a result, mental health services in the region are being redefined and expanded, and this was realised with the launching of the ambitious National Mental Health Strategy in 2013. Traditionally, mental healthcare in Qatar had been considered to be the remit of psychiatrists within secondary care. The new strategy supported the transition towards community-based care. It outlined a plan to design and build a comprehensive and integrated mental health system, offering treatment in a range of settings. In this article, we provide an overview of the advent of primary care mental health services in Qatar. We discuss the historical aspects of psychiatric care and development of primary care mental health services in Qatar.

Early interventions improve outcomes for people at high risk of psychosis and are likely to be cost saving. This group tends to seek help for emotional problems - depression and anxiety - via primary care services, where early detection methods are poor. We sought to determine prevalence rates of high risk for psychosis in UK primary care mental health services and clinical outcomes following routinely delivered psychological therapies. We used a brief screen designed for settings with low base rates and significant time constraints to determine prevalence of high risk for psychosis in UK 'Talking Therapies' services. We examined socio-demographic characteristics, presenting problems and recovery trajectories for this group, compared with people not at risk of psychosis. A 2-item screen selected for specificity yielded a prevalence rate of 3% in primary care mental health services. People at elevated risk of psychosis were younger and more likely to report at least one long-term physical condition. This group presented with higher levels of depression, anxiety and trauma symptoms at assessment and were less likely to have recovered at the end of treatment, compared to people not at risk. Very brief screening tools can be implemented in busy health care settings. The 3% of referrals to UK primary care psychological therapies services at elevated risk of psychosis typically present with more severe symptoms and greater levels of comorbidity and may require augmented interventions to recover fully.

Improving the management of depression in primary careWith the overarching aim of making the management of depression easier, Lewisham PCT have implemented a multifaceted programme to develop primary health care workers' skills, knowledge and resources so as to improve their service to patients with depression. Now in its second year, the programme has, and still is, constantly evolving. This article outlines the programme's key messages and components during its first year, and briefly refers to its expansion and future aims.Primary care mental health services for 16‐19 year oldsStudies suggest that many young people who would benefit from accessing mental health services do not do so, as they fall into the gap between child and adult services. This report outlines the results of a project carried out within Bury Mental Health Services to establish what young people want from primary care mental health services and whether current service provision meets their needs. Copyright © 2007 Wiley Interface Ltd

BackgroundIntegration of mental health services into primary healthcare is proliferating in low-resource countries. We aimed to evaluate the impact of different compositions of primary care mental health services for depression and alcohol use disorder (AUD), when compared to usual primary care services.MethodsWe conducted a non-randomized controlled study in rural Nepal. We compared treatment outcomes among patients screening positive and receiving: (a) primary care mental health services without a psychological treatment component (TG); (b) the same services including a psychological treatment (TG + P); and (c) primary care treatment as usual (TAU). Primary outcomes included change in depression and AUD symptoms, as well as disability. Disability was measured using the 12-item WHO Disability Assessment Schedule. Symptom severity was assessed using the 9-item Patient Health Questionnaire for depression, the 10-item Alcohol Use Disorders Identification Test for AUD. We used negative binomial regression models for the analysis.ResultsFor depression, when combining both treatment groups (TG, n = 77 and TG + P, n = 60) compared to TAU (n = 72), there were no significant improvements. When only comparing the psychological treatment group (TG + P) with TAU, there were significant improvements for symptoms and disability (aβ = − 2.64; 95%CI − 4.55 to − 0.74, p = 0.007; aβ = − 12.20; 95%CI − 19.79 to − 4.62; p = 0.002, respectively). For AUD, when combining both treatment groups (TG, n = 92 and TG + P, n = 80) compared to TAU (n = 57), there were significant improvements in AUD symptoms and disability (aβ = − 15.13; 95%CI − 18.63 to − 11.63, p < 0.001; aβ = − 9.26; 95%CI − 16.41 to − 2.12, p = 0.011; respectively). For AUD, there were no differences between TG and TG + P. Patients’ perceptions of health workers’ skills in common psychological factors were associated with improvement in depression patient outcomes (β = − 0.36; 95%CI − 0.55 to − 0.18; p < 0.001) but not for AUD patients.ConclusionPrimary care mental health services for depression may only be effective when psychological treatments are included. Health workers’ competencies as perceived by patients may be an important indicator for treatment effect. AUD treatment in primary care appears to be beneficial even without additional psychological services.

Evolution of Child Mental Health Services in Primary Care

Mental health services worldwide, including in the UK, face significant constraints that necessitate effective resource planning for delivering high-quality care. The application of analytics in healthcare offers the potential to enhance efficiency and improve care quality. However, achieving this vision is particularly challenging in the context of mental healthcare. This paper focuses on the evaluation and redesign of a Primary Care Mental Health (PCMH) service located in Kent, UK. To address this problem, we propose an analytics-driven approach that integrates the three stages of descriptive, predictive, and prescriptive analytics with an optimization model. Through a comprehensive case study, we illustrate how this integrated approach serves as a valuable tool for experimentation within the PCMH service. We explicitly detail how data analysis and stakeholder engagement informed model development. The findings of our novel multi-skill multi-location model demonstrate the benefits of utilising optimised workforce planning to reduce unmet demand while ensuring equitable workload distribution among clinicians. We also discuss the adaptability of the analytics approach and the potential applicability of the optimization model in mental health and other care settings.

Individuals with significant mental health problems (SMHP) have historically faced challenges accessing mental health care due to gaps between primary and secondary care services. The National Health Service (NHS) Long Term Plan aims to bridge this gap through the introduction of integrated primary care services that provide holistic, person-centred, multidisciplinary support for people with SMHP. This evaluation aimed to explore the experience of service users, carers and staff working within this new model of care. A qualitative approach was employed, and semi-structured interviews were conducted with N = 123 participants (n = 106 staff, n = 15 service users, n = 2 carers). Thematic analysis identified three themes: ‘opening doors and improving experiences’, ‘tailored and timely care’ and ‘connected communities’. Findings showed that the Integrated Primary Care Mental Health Service enabled earlier and easier access to mental health support for people with SMHP and supported community engagement and cross-collaboration between the NHS and partner agencies. The findings underscore the value of the Integrated Service in providing accessible, comprehensive, and person-centred mental health support at a primary care level, highlighting the benefits of cross-partnership working.

Objectives: The aim of this study was to determine whether implementation of primary care mental health services is associated with differences in specialty mental health clinic use within the Veterans Health Administration (VHA). Methods: The authors compared over a one-year period the new use of specialty mental health clinics and psychiatric diagnosis patterns among patients of 118 primary care facilities that offered integrated mental health care with 142 facilities without this service, with adjustment for other facility characteristics. Results: Patients at both types of primary care facilities (those with integrated mental health care and those without) initiated specialty mental health treatment at similar rates (5.6% versus 5.8%) and averaged similar total specialty mental health clinic visits (7.0 versus 6.3). There were no significant differences in diagnosis patterns. Conclusions: Initial national implementation of mental health care in primary care within the VHA was not associated with substantial differences in new specialty mental health clinic use or diagnostic case mix among primary care patients. (Psychiatric Services 62:422–425, 2011)

The aim of this study was to determine whether implementation of primary care mental health services is associated with differences in specialty mental health clinic use within the Veterans Health Administration (VHA). The authors compared over a one-year period the new use of specialty mental health clinics and psychiatric diagnosis patterns among patients of 118 primary care facilities that offered integrated mental health care with 142 facilities without this service, with adjustment for other facility characteristics. Patients at both types of primary care facilities (those with integrated mental health care and those without) initiated specialty mental health treatment at similar rates (5.6% versus 5.8%) and averaged similar total specialty mental health clinic visits (7.0 versus 6.3). There were no significant differences in diagnosis patterns. Initial national implementation of mental health care in primary care within the VHA was not associated with substantial differences in new specialty mental health clinic use or diagnostic case mix among primary care patients.

OBJECTIVES. To evaluate the effectiveness of a two session guided self-help (GSH) intervention provided by primary care graduate mental health workers (PCGMHWs) in a primary care mental health service. DESIGN. Pragmatic randomized trial, with a wait list control design. METHOD. Patients presenting with significant anxiety and depression problems were given one or more self-help booklets at screening and randomly allocated to an immediate (ITG) or delayed treatment group (DTG). Following this, a two-session GSH intervention was provided by one of two PCGMHWs, with a review session to decide on the need for further intervention. The DTG began the intervention 8 weeks after the screening and the primary outcome was Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) scores after 8 weeks. RESULTS. A total of 63 patients were allocated to the ITG, 59 to the DTG. Analysis of covariance, carried out on an intention to treat basis, showed a significant treatment effect, F(1,98) = 15, p < .001, and a comparison of means at 8 weeks showed a significant difference, t(116) = 2.1 (95% CI [1.1, 5.9]), p= .042 with an effect size, d= 0.375. Taking the two groups together, CORE-OM scores for patients who completed the intervention reduced between screening and the review session by an average of 7.9 (95% CI [6.3, 9.5]), effect size of 1.2. Between screening and the review session, 47% showed a reliable and clinically significant improvement. CONCLUSIONS. The study provides some support for the effectiveness of a two-session GSH intervention and a stepped-care service model.

The integration of mental health services into primary care is a globally acclaimed strategy to close the treatment gap for mental disorders, but it has also been criticised for encouraging the medicalisation of everyday life. In Chile, this strategy has gained support and spread quickly in the last decades, and today, all primary public care centres have incorporated a mental health service. However, although some reports highlight problems that have arisen with integrated primary care, the critical social analysis of its impact on services, teams and communities is scarce. This article aims to analyse how primary public mental healthcare services (PPMHSs) in Chile could be contributing to medicalise life. Health policies, reports, evidence from research on local public health issues and the author’s experience are examined to develop the arguments. It is suggested that issues with the universal health access and integrated primary public care policies and the institutionalised use of standard classifications of mental disorders support the survival of a reductionist biomedical disease model and a trend to psychopathologise life. We conclude that these factors underpin the medicalisation of everyday life in primary public mental healthcare services in Chile. Critical engagement with daily practice is necessary to prevent PPMHSs from disempowering people and communities by providing them with medicalised solutions, instead of generating agency in their everyday problem-solving behaviours.