Access To Mental Health Care Research Articles

Patient-Reported Outcomes Among Adults With Congenital Heart Disease in the Congenital Heart Initiative Registry

In the US, there are more than 1.5 million adults living with congenital heart disease (CHD). The Congenital Heart Initiative (CHI) is a digital, online, patient-empowered registry that was created to advance multicenter research and improve clinical care by gathering patient-reported outcomes (PROs) in adults with CHD. To report the initial findings of the PROs for adults with CHD from the first 3 years of the CHI. The CHI was launched nationally on December 7, 2020, as an observational cohort (survey) study. Data were collected virtually through December 31, 2023, and stored on Health Insurance Portability and Accountability Act-compliant cloud-based servers with restricted access. Adults with CHD were recruited through email, social media, general advertising through advocacy organizations, and targeted outreach (telephone and in-clinic recruitment) by clinical centers. Demographics and validated survey tools on quality of life, mental health, physical activity, and health care utilization were collected at baseline and every 4 months. Descriptive statistics were used to understand the associations between various factors, including the complexity of heart defects, physical activity levels, mental health comorbidities, and socioeconomic and health care access variables. All categorical variables were analyzed using χ2 or Fischer exact test as appropriate. By December 31, 2023, the CHI had enrolled 4558 participants (2530 female [56%]) with a mean (SD) age of 38.5 (13.9) years, representing all 50 states. Approximately 88% of participants (3998 participants) completed at least 1 electronic visit as of December 31, 2023. The most prevalent CHD anatomy included tetralogy of Fallot (883 participants [22%]), transposition of great arteries (452 participants [11%]), and coarctation of the aorta (429 participants [11%]). Approximately 88% of participants (3998 participants) reported at least 1 comorbidity, with arrhythmia (1300 participants [33%]) as the most common cardiac comorbidity and mood disorder (1326 participants [35%]) as the most common noncardiac comorbidity. Among female participants, 45% (1147 participants) reported having had a pregnancy, with 38% (967 participants) resulting in biological children. Participants with complex CHD were less likely than those with moderate CHD to meet recommended physical activity guidelines (χ22 = 15.9; n = 3320; P < .001), a factor that was more pronounced among female participants. Overall health-related quality of life was rated as good or better by 84% of participants who completed the quality of life PROs (2882 participants), with no difference by CHD complexity. In this cohort study of adults living with CHD, many patients reported mood disorders, but most reported good health-related quality of life. The CHI, the largest registry of adults with CHD, is poised to facilitate multicenter research with the goal of improving clinical outcomes for all adults with CHD.

Postpartum Mental Health Care Use Among Parents During Simultaneous Parental Leave

Flexible parental leave schemes can help families balance work, childcare, and postpartum treatment, including treatment for mental health. In Sweden, both parents are eligible to use parental leave simultaneously in the first year after birth; however, the consequences for postpartum mental health care uptake remain underinvestigated. To examine the association between parents' use of simultaneous parental leave and their use of postpartum mental health care in Sweden. This cohort study obtained baseline data from national registries in Sweden, including live births of singleton offspring between January 1, 2014, to December 31, 2015, and simultaneous parental leave use (any vs none) in the 12 months after birth. The population-based sample was composed of parental dyads (mothers and fathers) who were eligible for simultaneous parental leave and were followed up from January 1, 2015, to December 31, 2016. Statistical analyses were conducted between December 15, 2023, and August 14, 2024. Simultaneous parental leave use up to 12 months post partum. Total population register data were used to identify maternal and paternal outpatient care visits for mental health (substance use disorder [SUD], mood or affective disorders, and stress-related disorders) and psychotropic prescription dispensations (antidepressants and anxiolytics) during the first postpartum year. Logistic regression was applied to estimate the odds of these outcomes by simultaneous parental leave use, controlling for parents' age, sociodemographic characteristics, and prebirth mental health care use. Robustness analyses using propensity score matching were performed. The sample comprised 207 283 parental dyads, of whom 153 342 (74.0%) did not use simultaneous parental leave in the first postpartum year and 53 941 (26.0%) did. Among those who used simultaneous parental leave, the mean (SE) age at childbirth was 29.63 (0.02) years for mothers and 32.80 (0.03) years for fathers. Compared with mothers who did not use parental leave simultaneously with their partners, mothers who did were more likely to receive antidepressant prescriptions in the first postpartum year (odds ratio [OR], 1.07; 95% CI, 1.02-1.11). Fathers who used simultaneous parental leave vs those who did not had increased odds of SUD-related outpatient care visits (OR, 1.10; 95% CI, 1.02-1.20). Longer simultaneous parental leave was associated with greater odds of mental health care use for both parents, and earlier leave was associated with greater odds of health care use by mothers. Findings for mothers, but not fathers, remained significant in robustness analyses using propensity score matching. This cohort study found that simultaneous parental leave use was associated with greater health care uptake for postpartum mental health conditions in both mothers and fathers. This finding supports the need to consider the benefits of generous family policies as well as the risks of structural obstacles to postpartum mental health care access across the world.

Perspective: Expanding Pediatric Mental Health Care Access Programs Into Hospital Settings.

Perspective: Expanding Pediatric Mental Health Care Access Programs Into Hospital Settings.

Persons with Disabilities Living in Rural Areas of Bangladesh: An Exploration of Their Mental Health and Experiences in Accessing Support During the COVID-19 Pandemic

ABSTRACT The COVID-19 pandemic has presented a major public health challenge across the world, including in Bangladesh. Little scholarly work has explored the mental health experiences of persons with disabilities in rural areas of Bangladesh during the pandemic. A qualitative case study was conducted in the rural areas of Narayanganj, Gazipur, and Narsingdi. A total of 13 in-depth interviews (IDIs) with persons with disabilities and 13 key informant interviews (KIIs) with different stakeholders and caregivers were conducted. Thematic analysis was used to analyse the data. The findings revealed five major themes: lockdown-induced mental health problems, including fear of infection, symptoms of anxiety and depression, sleep disturbance, suicidal ideation, and domestic violence; perceived attitude towards mental health issues, including stigma and discrimination; perceived vulnerability was observed in relation to gender, age, and type of disability; barriers to seeking mental health care including distance, financial burden, and indifference towards mental health care; and finally, availability of mental health care which reaffirms a lack of mental health care in rural areas. The findings highlight the importance of integrating mental health into the primary healthcare system with a focus on persons with disabilities to minimise mental health repercussions during times of emergency.

An analysis of demographic, socio-economic and clinical variables for mental illness and mental illness relapse in south-east nigeria

Mental health has come into the front burner of development challenges amid declining socio-economic outcomes, especially in developing countries. Insecurity, conflicts and extremely threatening events, which trigger mental disorders, are common in South-East Nigeria, with many military operations, unknown gunmen attacks and kidnapping leading to the cold-blood assassination and kidnap of dear ones. The study aimed to analyze the demographic, socio-economic and clinical variables for mental illness in South-East Nigeria. Consecutive sampling technique was used to obtain a three-year records of the cases of 380 index and 180 post-index points data of mental illness cases that met the inclusion criteria in a purposively selected public mental health hospital. Data were analyzed using both descriptive and inferential statistics, including frequency count, percentages, chi-square and multinomial logistic regression. Results showed that over a half (55.0%) of the patients were males, and 65.27% had post-primary education. The mean age of patients was 39.87 years. Slightly above half of the cases (55.26%) were single and 56.84% were unemployed. Schizophrenia (68.42%) topped the list of the cases. The rate of relapse was 52.1%, with males being in the majority (61.62%). About 61.62% of those who relapsed were unemployed, 9.60% were into business/trading, and 5.05% were professionals. Those with 5 years and above illness duration had a higher percentage of relapse (52.02%) as well as those with poor drug compliance (66.16%). The mean relapse age was 34.23 years. Educational status, employment status/social class, marital status, and age were socio-economic/clinical factors that associated strongly with relapse at p-value of 0.10. Patients with ≥ 5 and ≤ 3 years duration of illness were 1.17 times on the average more likely to have relapse than those with three or less than 3 years. Onset age for illness predicted 2.479 times more likelihood of relapse. Being employed and having more family support, as against being unskilled/unemployed and not having family support, reduce the likelihood of relapse by 1.110 times on the average. The study recommended policy formulation and implementation for protection against mental illness and mental healthcare provision and access; for tackling unemployment head-on; for improvement of the access to effective treatment of mental illness; and mass education, especially among unemployed, uneducated, singles, and under-35 years of age, to help reduce the high rate of relapse of mental illness in South-East Nigeria.

Intersectional disparities in access to mental health services among youth aging out of foster care

BackgroundYouth aging out of the child welfare system lack support in accessing needed mental health care, as do youth of color and LGBTQ ​+ ​youth in the general population. Similar disparities may exist among youth aging out of foster care who hold intersecting social identities. ObjectiveThis study aimed to explore the presence of mental health care access disparities among youth aging out of foster care using an intersectional lens. Participantsand Setting: The current study was a cross-sectional, exploratory analysis of secondary data from the Jim Casey Youth Opportunities Initiative (JCYOI) dataset. The sample included 2650 youth aging out of care. MethodsThe current study utilized bivariate tests to explore the association between access to mental health care and key variables, a rate ratio to measure access disparities, and logistic regression to determine the main effect of identity on mental health care access. FindingsLower rates of mental health care access were found among youth of color compared to White youth and among LGBTQ ​+ ​youth compared to non-LGBTQ ​+ ​youth. Disparities increased when youth of color also identified as LGBTQ+, however identity was not a significant predictor of mental health care access when controlling for insurance coverage and other variables. ConclusionsDisparities in access to needed mental health care found in the general population are also present among youth aging out of foster care. These findings suggest the need for targeted efforts from practitioners to ensure equitable access to mental health care for transition aged youth.

Can Artificial Intelligence Chatbots Improve Mental Health?: A Scoping Review.

Mental health disorders, including anxiety and depression, are the leading causes of global health-related burden and have increased dramatically since the 1990s. Delivering mental healthcare using artificial intelligence chatbots may be one option for closing the gaps in mental healthcare access. The overall aim of this scoping review was to describe the use, efficacy, and advantages/disadvantages of using an artificial intelligence chatbot for mental healthcare (stress, anxiety, depression). PubMed, PsycINFO, CINAHL, and Web of Science databases were searched. When possible, Medical Subject Headings terms were searched in combination with keywords. Two independent reviewers reviewed a total of 5768 abstracts. Fifty-four articles were chosen for further review, with 10 articles included in the final analysis. Regarding quality assessment, the overall quality of the evidence was lower than expected. Overall, most studies showed positive trends in improving anxiety, stress, and depression. Overall, using an artificial intelligence chatbot for mental health has some promising effects. However, many studies were done using rudimentary versions of artificial intelligence chatbots. In addition, lack of guardrails and privacy issues were identified. More research is needed to determine the effectiveness of artificial intelligence chatbots and to describe undesirable effects.

State Differences in Children’s Mental Health Care

ObjectivesThis study estimates and compares variation in the probability of child unmet need for mental health care and difficulties accessing care for each state in the United States. Estimates are also generated and compared for three socioeconomic and demographic subgroups nationwide: racial/ethnic group, household income, and insurance type. MethodsUsing a retrospective, cross-sectional design, this study pooled 2016-2019 National Survey of Children’s Health data. National, state, and subgroup adjusted probabilities of caregiver-reported child unmet need for mental health care and ease of access to mental health care were generated from logistic regression models with marginal post-estimation. ResultsAdjusted national probabilities of caregiver-reported child unmet mental health need and difficulty in accessing care were 0.21 and 0.46, respectively. State probabilities of unmet need ranged from 0.08 to 0.32. One state was significantly above the national estimate; nine states were below it. State probabilities of difficulty accessing mental health care ranged from 0.28 to 0.57; nine states’ probabilities were significantly below the national estimate and two states were significantly above it. Estimates of unmet mental health need and difficulty accessing care varied more widely across states than across racial or ethnic groups, income groups, insurance groups. ConclusionsGeographic inequities in children’s mental health care access persist; in some cases, they are larger than sociodemographic inequities.

Understanding parenting responsibilities as a challenge to mental healthcare access for mothers with a mental illness in Tyrol, Austria

It is estimated that one out of three individuals will experience a mental illness at some point in their lives. Parenting with a mental illness can be particularly challenging and often requires additional support and resources to navigate through it. One of the challenges is accessing mental healthcare while also having parenting responsibilities. This study aims to explore how mothers with a mental illness in Tyrol, Austria, experience the impact of their parenting responsibilities in terms of accessing mental healthcare, and which processes contribute to such challenges. We draw from 20 semi-narrative interviews with mothers with a mental illness which were conducted in the context of a larger research project, focusing on developing and evaluating support for families with a parent with a mental illness. We identified three main findings affecting access to mental healthcare services: (1) organisational issues with mental healthcare services, (2) socio-cultural norms around family and care work, and (3) identity-related expectation of being a ‘good mother’ who is always there for her children. The concern for the children's wellbeing was also closely linked to these aspects. It is important, however, to consider the ways in which these findings are interwoven, and that social support could mitigate challenges. The findings of this study contribute to understanding childcare responsibility as a significant challenge to accessing mental healthcare for mothers with a mental illness and recognising it as a structural, socio-cultural, and identity-related phenomenon.

The impact of the COVID-19 pandemic on mental health care utilization among people living with HIV: A real-world data study.

The COVID-19 pandemic has profoundly impacted mental health worldwide, particularly among vulnerable populations such as people living with HIV (PLWH). However, large-scale, real-world data on mental health care utilization and associated factors among PLWH remain limited. This study leveraged electronic health records (EHR) and Basics survey data from the All of Us program to explore mental health care utilization and associated factors among PLWH during the COVID-19 pandemic. Using a retrospective cohort design, we identified and included 4,575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) concept sets from the All of Us program between March 2018 and March 2022. Mental health care utilization was measured using the yearly count of mental health care visits over this period. The pattern of mental health care utilization was compared between pre-pandemic (2018-2020) and during the pandemic (2020-2022). Incidence rate ratios (IRR) from the Poisson generalized linear mixed models (GLMM) were used to examine associations between mental health care utilization, history of COVID-19 infection, demographic factors, pre-existing chronic conditions (e.g., hypertension, diabetes), and socioeconomic status. Among 4,575 PLWH, the annual number of mental health care visits decreased significantly during the pandemic period (March 2020 - March 2022) compared to the pre-pandemic period (March 2018 - February 2020) (IRR = 0.89, p < 0.001). The Poisson regression analysis found that a history of COVID-19 infection was associated with a higher number of mental health care visits (IRR = 1.35, p < 0.001). Middle-aged groups with participants aged 30-39 (IRR= 2.35, p = 0.002), 40-49 (IRR= 3.49, p < 0.001), and 50-64 (IRR= 2.07, p = 0.004) had significantly higher visit numbers compared to the youngest group (18-29 years). Black or African American participants were less likely to have visits compared to White participants (IRR = 0.71, p = 0.002). Medicaid health insurance was associated with an increase (IRR = 1.29, p = 0.007), while employer- or union-sponsored insurance was associated with a decrease in mental health care utilization (IRR = 0.54, p < 0.001, p < 0.001). Pre-existing comorbidities greatly increased the number of mental health care visits (one comorbidity: IRR = 5.49, two or more: IRR = 10.4, p < 0.001). Our study reveals a significant decrease in mental health care utilization and the diverse experiences of mental healthcare among PLWH during the COVID-19 pandemic. These findings underscore the importance of addressing disparities in mental health care access, particularly during public health emergencies, and suggest the need for tailored interventions to meet the mental health care needs of PLWH.

Abstract B155: “Quite devastating, traumatic and lonely”: The mental health experiences of Hispanic/Latino rectal cancer patients

Abstract Background: Numerous studies have shown that emotional distress increases after a cancer diagnosis. Psycho-oncology literature also indicates that Hispanic/Latino patients are less likely to receive mental health care after being diagnosed, placing them at risk of poor psychological adjustment. The purpose of this qualitative analysis was to explore how Hispanic/Latino adults experience their rectal cancer journey, how their needs change between receiving their initial diagnosis and undergoing treatment, and what can be done to help process difficult emotions at each phase. Methods: We partnered with Visión y Compromiso, a network of promotores (Spanish-speaking community health workers), to recruit 20 Hispanic/Latino rectal cancer patients and/or their caregivers in California's Bay Area and Central Valley. Semi-structured interviews were conducted in-person or virtually; participants could also choose their preferred language. Using reflexive data analysis, themes were developed and refined iteratively amongst a diverse team of researchers. Results: We identified three main themes. The first is the reactions experienced during initial diagnosis and what triggered these emotions. Patients reported experiencing fear, going blank, and feeling traumatized from the hurried and emotionally distant delivery of their diagnosis, thinking they’re going to die, and contemplating their quality of life. The second theme focused on what emotions were felt during treatment and what caused the feelings. Patients conveyed feeling depressed, frustrated, and embarrassed during their treatment due to pain, treatment difficulties, and poor communication from their providers. Treatment difficulties for this population included being racially profiled, fear of losing insurance coverage, and mounting hospital and transportation costs. Lastly, patients reported what helped them cope and/or what could help others. Religion/faith and support from caregivers were mentioned as coping strategies with the caveat that caregiver burnout is a risk. Better communication from the treatment team was an actionable recommendation. Examples of this included providers being more sensitive when conveying the initial diagnosis, providers explaining complex concepts in layman’s terms during the treatment process and having a Spanish translator available at each phase. Conclusion: Hispanic/Latino rectal cancer patients endure emotional distress at multiple stages of their cancer journey; tailored interventions may mitigate this psychological burden. Previous studies have shown that promotores can help reduce health disparities within the Hispanic/Latino population. In the context of our results, promotores could connect cancer patients to resources to address or cope with stressors, which may help bridge the gap in mental health care access and utilization. Future interventions with promotores should be explored as a way to provide culturally and linguistically concordant emotional support for patients and their caregivers at each step of the cancer journey. Citation Format: Zaria N. Cosby, Eleanor Brown, Julian P. Howland, Lucas K. Carpenter, Min Young Kim, Kristen M. Davis-Lopez, Patricia Castañeda, Maria Gonzalez, Miriam T. Hernandez, Ysabel Duron, Gladys M. Rodriguez, Sandra S. Zaky, Arden M. Morris, Aaron J. Dawes. “Quite devastating, traumatic and lonely”: The mental health experiences of Hispanic/Latino rectal cancer patients [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B155.

Evaluating the tailored implementation of a multisite care navigation service for mental health in rural and remote Australia (The Bridging Study): protocol for a community-engaged hybrid effectiveness-implementation study

BackgroundA dramatic decline in mental health of people worldwide in the early COVID-19 pandemic years has not recovered. In rural and remote Australia, access to appropriate and timely mental health services has been identified as a major barrier to people seeking help for mental ill-health. From 2020 to 2021 a care navigation model, Navicare, was co-designed with rural and remote communities in the Greater Whitsunday Region of Central Queensland in Australia. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to design and guide multiple aspects of a multisite study, The Bridging Study, to evaluate the implementation of Navicare in Australia.MethodsA community-engaged hybrid effectiveness-implementation study design will focus on the tailored implementation of Navicare at three new sites as well as monitoring implementation at an existing site established since 2021. Study outcomes assessed will include sustained access as the co-primary outcome (measured using access to Navicare mental health referral services) and Proctor’s Implementation Outcomes of feasibility, acceptability, appropriateness, adoption, fidelity, implementation cost, and sustainability. Data collection for the implementation evaluation will include service usage data, community consultations, interviews, and workshops; analysed using mixed methods and guided by EPIS and other implementation frameworks. Pre-post effectiveness and cost-consequence study components are embedded in the implementation and sustainment phases, with comparison to pre-implementation data and value assessed for each EPIS phase using hospital, service, and resource allocation data. A scaling up strategy will be co-developed using a national roundtable forum in the final year of the study. Qualitative exploration of other aspects of the study (e.g., mechanisms of action and stakeholder engagement) will be conducted.DiscussionOur study will use tailoring to local sites and a community-engaged approach to drive implementation of a mental health care navigation service in rural and remote Australia, with expected benefits to mental healthcare access. This approach is consistent with policy recommendations nationally and internationally as building blocks for rural health including the World Health Organization Framework for Action on Strengthening Health Systems to Improve Health Outcomes.Trial registrationProspectively registered on April 2, 2024, on the Australian New Zealand Clinical Trials Registry, no. ACTRN12624000382572. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386665&isReview=true.

Enablers of and Barriers to Perinatal Mental Healthcare Access and Healthcare Provision for Refugee and Asylum-Seeking Women in the WHO European Region: A Scoping Review.

Perinatal mental health is a growing public health concern. Refugee and asylum-seeking women are particularly susceptible to experiencing perinatal mental illness and may encounter a range of challenges in accessing healthcare. This scoping review sought to identify the enablers of and barriers to healthcare access and healthcare provision for refugee and asylum-seeking women experiencing perinatal mental illness in the WHO European Region. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was applied. Nine databases and six grey literature sources were initially searched in April 2022, and an updated search was completed in July 2023. The search identified 16,130 records, and after the removal of duplicates and the screening process, 18 sources of evidence were included in this review. A data extraction table was used to extract significant information from each individual source of evidence, which was then mapped to the seven dimensions of the candidacy framework. Empirical (n = 14; 77.8%) and non-empirical (n = 4; 22.2%) sources of evidence were included. The literature originated from seven countries within the WHO European Region, including the United Kingdom (n = 9; 50%), Germany (n = 3; 16.7%), Denmark (n = 2; 11.2%), Norway (n = 1; 5.6%), Greece (n = 1; 5.6%), Sweden (n = 1; 5.6%), and Switzerland (n = 1; 5.6%). The results indicate that, although enablers and barriers were apparent throughout the seven dimensions of candidacy, barriers and impeding factors were more frequently reported. There was also a notable overall lack of reported enablers at the system level. Unaddressed language barriers and lack of attention to the diversity in culturally informed perceptions of perinatal mental illness were the main barriers at the individual level (micro-level) to identifying candidacy, navigating healthcare systems, and asserting the need for care. The lack of culturally appropriate alignment of healthcare services was the key organizational (meso-level) barrier identified. The wider structural and political contexts (macro-level factors), such as lack of funding for consultation time, focus on Western diagnostic and management criteria, and lack of services that adequately respond to the needs of refugee and asylum-seeking women, negatively influenced the operating conditions and wider production of candidacy. It can be concluded that there are multilevel and interconnected complexities influencing access to and provision of perinatal mental healthcare for refugee and asylum-seeking women.

Mental health disparities among first generation immigrants to the US

Mental health disparities among first-generation immigrants to the United States are intricately linked to the historical and sociopolitical context of immigration. The Immigration and Nationality Act of 1965 and policies such as Deferred Action for Childhood Arrivals (DACA) have shaped the demographic and experiential landscape of first-generation immigrants, influencing their mental health outcomes. Objective: This study aims to examine the mental health disparities experienced by first-generation immigrants in the United States, identifying the contributing factors and exploring effective strategies for addressing these disparities. Methods: A comprehensive literature review was conducted, analyzing studies on mental health outcomes among first-generation immigrants. The review focused on factors contributing to mental health disparities, including pre-migration experiences, migration-related stressors, post-migration challenges, and systemic barriers to mental health care access. The review also explored intersectionality and its impact on mental health, as well as case studies and examples of successful interventions. Results: The "immigrant paradox" suggests that immigrants often exhibit better mental health outcomes than native-born individuals, though this effect diminishes over time. Factors such as strong family ties and community support initially contribute to this mental health advantage. However, post-migration challenges, including acculturation stress, socioeconomic hardship, and discrimination, often lead to a decline in mental health. Certain mental health conditions, such as PTSD and anxiety disorders, are more prevalent among specific immigrant groups, particularly those fleeing conflict or persecution. Structural, cultural, and systemic barriers hinder access to mental health care, exacerbating disparities. Successful interventions often involve community-based approaches, culturally competent care, and integrated service models. Conclusion: Addressing mental health disparities among first-generation immigrants requires a multifaceted approach, including community engagement, policy interventions, and culturally competent care. By investing in research and implementing evidence-based interventions, it is possible to reduce mental health disparities and improve outcomes for first-generation immigrants. Future research should focus on long-term mental health trajectories, the impact of digital technologies, and the role of social networks.

Telepsychiatry Enables Better Mental Health Care Access in a Southern Philippines Hospital: a Mixed Methods Outcome Evaluation

The Philippines faces a significant unmet need for mental health care services, especially in remote and underserved areas with limited access to traditional in-person psychiatric services. Telepsychiatry offers a potential solution for bridging this gap and improving access to care. This study aimed to evaluate the telepsychiatry service in a Level 1 government hospital in southern Philippines and assess its feasibility for improving mental healthcare access. This evaluation study used a mixed-methods approach, including quantitative analysis of patient demographic data and psychiatric diagnoses retrieved from medical records (2018–2021), as well as qualitative in-depth interviews and focus group discussions with patients, guardians, and hospital staff. A SWOT (strengths, weaknesses, opportunities, threats) analysis was also conducted to assess areas for improvement. The majority of patients were between 18–35 yr old, male, and single. The most common diagnoses were schizophrenia spectrum and other psychotic disorders, followed by depressive and anxiety disorders. Key issues included medicine shortage, lack of communication, and poor Internet connectivity. However, stakeholders cited advantages such as access to free consultations, timely diagnosis, and potential for service scale- up. This study features telepsychiatry's potential for enabling better mental health care access in resource-constrained areas of the Philippines. It is the first to demonstrate telepsychiatry service provision from a specialist hospital to a Level 1 government hospital in the country. However, sustained multi-sector and multi-level coordination is crucial for long-term viability. Recommendations for enhancement and future research directions are provided.

Wellbeing in stroke and aphasia (WISA): protocol for a feasibility study setting up an accessible service offering psychological therapy to people with post-stroke aphasia

Background and aimFollowing a stroke, around a quarter of people will have aphasia, a language disability. Aphasia can have a devastating long-term impact on a person’s psychological wellbeing, yet their language difficulties make it challenging to access mental health care. The Wellbeing In Stroke and Aphasia (WISA) study aims to evaluate the feasibility of setting up an accessible psychological service for people with aphasia.MethodsThe service will be open to people with post-stroke aphasia (n = 30) who live in the UK, are able to access the service either in the university clinic or via telehealth and are not currently receiving therapy from a mental health professional. Participants will be offered up to 8 therapy sessions over 6 months, either one-to-one, with family, or in a group. The intervention is Solution Focused Brief Therapy (SFBT), a brief psychological therapy, delivered by speech and language therapists with training in SFBT under the supervision of a stroke-specialist clinical psychologist. As part of this service, a protocol for addressing mental health care has been developed. Feasibility will be assessed by monitoring referral rates, therapy received, discharge processes, resource capability, costs, challenges, and adverse events. Patient-reported outcome measures collected pre and post intervention will assess mental wellbeing, mood, participation, and satisfaction with therapy and the service. A purposive sample will take part in in-depth interviews following therapy.DiscussionGiven the high levels of psychological distress in this client group, there is a need to investigate innovative ways to provide accessible and acceptable psychological support.

“How can I seek a consultation if I don’t have a high fever ?”: Barriers to Mental Healthcare Access for Women in the Perinatal Period in Rwanda

“How can I seek a consultation if I don’t have a high fever ?”: Barriers to Mental Healthcare Access for Women in the Perinatal Period in Rwanda

Disparities and Medical Expenditure Implications in Pediatric Tele-Mental Health Services During the COVID-19 Pandemic in Mississippi.

Tele-mental health (TMH) services, including both mental and behavioral healthcare (MBH) services, emerged as a cornerstone in delivering pediatric mental healthcare during the coronavirus disease 2019 (COVID-19) pandemic, yet their utilization and effects on healthcare resource utilization (HCRU) and medical expenditures remain unclear. To bridge the gap, this study aims to investigate the association between TMH utilization and sociodemographic factors and assess its associated HCRU and medical expenditures within a pediatric population in Mississippi. Studying 1,972 insured pediatric patients who accessed outpatient MBH services at the study institution between January 2020 and June 2023, age, race, insurance type, rural residency, and household income were identified as key determinants of TMH utilization. Adjusting for sociodemographics, TMH utilization was associated with 122% more MBH-associated outpatient visits and 36% higher related medical expenditures, but 27% less overall medical expenditures. This study reveals sociodemographic disparities in pediatric TMH utilization, highlights its role in augmenting outpatient mental healthcare access, and shows its potential for cost savings. Future efforts should aim at fostering more digitally inclusive, equitable, and affordable pediatric mental healthcare services.

A Medical Student-Inspired Advocacy Effort to Improve Pediatric Mental Health Services

The demand for pediatric mental health services has exceeded the supply of mental health providers for decades and increased significantly during the COVID-19 pandemic. Given the federal administration’s interest in passing a major funding bill to address the COVID-19 pandemic, the authors recognized an opportunity to collaborate in an advocacy effort to request federal financial support for Pediatric Mental Health Care Access Programs (PMHCAPs). The challenges of the pandemic and limited travel became assets as the advocacy team, who lived hundreds of miles apart in 2 states, met virtually with each other and with Congressional staff during February of 2021 on a tight timeline. In March of 2021, President Biden signed the American Rescue Plan that provided $80 million for PMHCAPs.

What does it take to offer high-quality, community-based, accessible mental health care in Lebanon?

Background: Armed conflict, economic collapse, the 2020 explosion, the COVID-19 pandemic, and persistent political and social instability have had severe impact on mental health in Lebanon. Aim: To highlight the critical elements for setting up a free community-based mental health care centre in Lebanon. Methods: Following the Beirut blast in 2020, a non-government organization started providing free, essential, personcentred, and holistic mental health care to residents in Lebanon through a multidisciplinary team of psychiatrists, psychologists, social workers, and mental health nurses. Results: During its first year of operation, the health centre provided 5392 free mental health consultations to 590 beneficiaries. Majority (67%) of the beneficiaries were female, and nearly half (45%) were aged 18–24 years. The most prevalent mental health disorders were major depressive disorder, generalized anxiety disorder and post-traumatic stress disorder. Beneficiaries self-reported a 70% improvement in depression and a 76% improvement in anxiety after 3 months of treatment. Conclusion: Based on our experience, we advocate the community-based model as an effective approach to delivering mental health interventions and recommend a continuous evaluation of its impact in community settings.