Adult Mental Health Care Research Articles

Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations

BackgroundADHD in adults is a common and debilitating neurodevelopmental mental health condition. Yet, diagnosis, clinical management and monitoring are frequently constrained by scarce resources, low capacity in specialist services and limited awareness or training in both primary and secondary care. As a result, many people with ADHD experience serious barriers in accessing the care they need.MethodsProfessionals across primary, secondary, and tertiary care met to discuss adult ADHD clinical care in the United Kingdom. Discussions identified constraints in service provision, and service delivery models with potential to improve healthcare access and delivery. The group aimed to provide a roadmap for improving access to ADHD treatment, identifying avenues for improving provision under current constraints, and innovating provision in the longer-term. National Institute for Health and Care Excellence (NICE) guidelines were used as a benchmark in discussions.ResultsThe group identified three interrelated constraints. First, inconsistent interpretation of what constitutes a ‘specialist’ in the context of delivering ADHD care. Second, restriction of service delivery to limited capacity secondary or tertiary care services. Third, financial limitations or conflicts which reduce capacity and render transfer of care between healthcare sectors difficult. The group recommended the development of ADHD specialism within primary care, along with the transfer of routine and straightforward treatment monitoring to primary care services. Longer term, ADHD care pathways should be brought into line with those for other common mental health disorders, including treatment initiation by appropriately qualified clinicians in primary care, and referral to secondary mental health or tertiary services for more complex cases. Long-term plans in the NHS for more joined up and flexible provision, using a primary care network approach, could invest in developing shared ADHD specialist resources.ConclusionsThe relegation of adult ADHD diagnosis, treatment and monitoring to specialist tertiary and secondary services is at odds with its high prevalence and chronic course. To enable the cost-effective and at-scale access to ADHD treatment that is needed, general adult mental health and primary care must be empowered to play a key role in the delivery of quality services for adults with ADHD.

Complex emotional needs and older people: Setting standards for inclusion

Community Mental Health Transformation in England provides an opportunity to change the structure and culture of mental health care delivery in community services. It is vital that the needs of older people are equitably considered and resourced through this work. One of the key strands of community transformation relates to care provision of people with complex emotional needs, an area under-researched and recognised in older adult mental health care. This paper sets out the current landscape within NHS community services in England, the challenges of meeting the needs of this clinical group and the creation of a national document which lays out recommendations for services working to meet clinical needs of older people with complex emotional needs.

Review: System transformation to enhance transitional age youth mental health - a scoping review.

Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. There remains a need for innovative, evidence-based approaches to improve TAY mental health care.

Chicago's investment in coordination of MH response continues to grow

A recent investment of $3.1 million in local grants is designed to ensure that by September, residents of each of Chicago's 77 distinct neighborhoods will have convenient access to adult and child mental health care in the city's trauma‐informed centers of care (TICC) network. City officials say this latest development adds important momentum to a multi‐year effort to establish a “no wrong door” approach to care regardless of whether an individual enters the system via a city‐operated mental health center, a state‐funded community mental health center (CMHC), or a federally qualified health center (FQHC).

Receiving teletherapy in Ireland: The experiences of service users in the public mental health system

AbstractObjectiveThe present study explored the experiences of service users of Adult Mental Health and Primary Care services in Ireland in receiving teletherapy during the COVID‐19 pandemic to provide an illustration of these experiences which may inform future applications of teletherapy.MethodSemi‐structured telephone interviews about participants' experiences with teletherapy were conducted, the transcripts of which were analysed using reflexive thematic analysis.ResultsSix themes were generated: Early Apprehensions, Adaptations Improving Experiences, The Therapeutic Space, Seeing and Being Seen, Technical Difficulties: The Loss of “The Moment,” and The Security of a Pre‐Existing Relationship.ConclusionGenerated themes highlight both the range of experiences that clients can have during teletherapy, and some of the most significant factors which influence these experiences. The quality and effectiveness of teletherapy are often susceptible to factors outside of therapists' and clients' control. In most cases, it may be best considered as a supplement to, rather than a replacement for, traditional in‐person services.

Mandatory Check for COPMI in Adult Mental Healthcare Services in the Netherlands-A Quantitative and Qualitative Evaluation.

BackgroundChildren of parents with a mental disorder and/or addiction (COPMI) are at increased risk of developing a mental disorder. In spite of preventive interventions that can decrease the risk of problem development, COPMI are not automatically offered help. In 2013, a mandatory COPMI check was implemented in the Netherlands, requiring every mental health care professional to check whether their adult patients have children and to assess these children's safety and needs. Earlier research has shown that a gap between these regulations and the actual integration in clinical practice is not uncommon.MethodIn the current study, we evaluated the implementation of the mandatory COPMI check in the Netherlands, using quantitative as well as qualitative data from a large mental healthcare organization in the Netherlands that offers both Child and Adolescent Mental Health and Adult Mental Healthcare.ResultsFiles from 14,469 patients were analyzed quantitatively and a sample of 150 files was further analyzed in depth. Findings were refined through 4 focus groups with adult mental healthcare professionals. It was found that while there are examples of the tool leading to interventions for COPMI, the tool is often not used, and when used tends to direct the focus away from COPMI needs and organizing help toward the more narrow and problematic focus on safety and reporting to child abuse authorities.ConclusionThe potential of the COPMI check is currently not fully realized. Strategies to improve its effectiveness in clinical practice are needed to improve access to interventions for COPMI.

How Does It Feel to Have One's Psychiatric Diagnosis Altered? Exploring Lived Experiences of Diagnostic Shifts in Adult Mental Healthcare.

BackgroundThough the socio-emotional significance of psychiatric diagnoses and the frequency of transitions between diagnostic classifications are widely acknowledged, minimal research reveals how “diagnostic shifts” are subjectively experienced by psychiatric service-users.AimThis study investigated how adult service-users make sense of diagnostic shifts and their impacts on one's life.MethodsTwenty-seven people with self-reported experiences of diagnostic shifts opted into this qualitative study. Virtual narrative interviews invited participants to share their “diagnosis stories.” Interview transcripts were analyzed using narrative thematic analysis to identify common and divergent experiences across participants.ResultsDiverse experiences of diagnostic shifts were related: diagnostic shifts could both promote and undermine clinical trust, therapeutic engagement and self-understanding. The analysis suggested that shared and divergent experiences could be attributed to two dimensions of narratives: participants' Interpretations of Diagnostic Shifts and Diagnosis-Specific Factors. Regarding the former, analysis produced a typology of three possible interpretations of diagnostic shifts, which were linked with consistently different antecedents, experiences and consequences. The latter dimension captured how experiences of diagnostic shifts also hinged on the unique meanings ascribed to the specific diagnoses gained and lost, particularly in relation to their perceived severity, stigma, personal associations, and related communities.ConclusionsFindings revealed how diagnostic shifts can be experienced as both traumatic and life-enhancing, depending on their social and subjective context. Understanding the range and predictors of variable experiences of diagnostic shifts is vital for sensitive clinical practice and communication.

Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted.

Mental Health Care for Adults Treated With Dialysis in Canada: A Scoping Review.

Purpose of review:Mental illnesses, especially depression and anxiety, are common conditions frequently underrecognized and untreated among individuals with end-stage kidney disease. Existing tools/interventions, approaches to care, and resources to support mental health for people treated with dialysis in Canada are not well known. The aim of this scoping review was to systematically describe how mental health care is provided to adults treated with dialysis in Canada. The research questions we sought to answer were the following: (1) What mental health assessment tools and interventions for adults treated with dialysis have been investigated and utilized in Canada? (2) what is the structure and process of mental health care delivered by kidney care to adults treated with dialysis in Canada? and (3) what is the availability of mental health care resources developed for adults treated with dialysis in Canada?Sources of information:Electronic databases included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, Scopus, and Web of Science for peer-reviewed literature, and Google search engine for gray literature.Methods:Systematic searches were conducted to identify peer-reviewed and gray literature that focused on mental health care or support offered to adults receiving any form of dialysis in Canadian kidney care settings and/or community organizations. Mental health care and support was defined to include mental health assessment tools, interventions, resources, guidelines, and/or pathways used in dialysis in Canada. Title, abstracts, and full texts were screened independently by 2 reviewers with discrepancies resolved by additional team members. Web sites were screened by individual members. Data from included studies and Web sites were extracted based on the abovementioned research questions.Key findings:We identified 8 peer-reviewed articles from electronic databases, and 28 separate Web site addresses. Of the 8 articles, 4 investigated mental health assessment tools and 4 examined mental health interventions for individuals treated with dialysis in Canada. The mental health assessment tools that have been used are Beck Depression Inventory-II (BDI-II), Edmonton System Assessment Scale (ESAS), Edmonton System Assessment Scale revised (ESAS-r): Renal, Hospital Anxiety and Depression Scale (HADS), and Distress Assessment and Response Tool (DART), and the nonpharmacological interventions that have been investigated are intradialytic exercise, tai chi exercise program, medical music therapy, and brief mindfulness meditation. Of the 28 Web site addresses, 2 contained clinical tools for kidney care providers for the management of depression and anxiety in individuals treated with dialysis. The 26 remaining Web sites contained mental health resources for individuals with kidney disease, which presented different types of resources, including psychoeducation, peer support, and linkage to other services.Conclusion:In conclusion, we found only a limited number of studies investigating mental health assessment tools and interventions in Canada; there was a paucity of randomized controlled trials. Clinical pathways for the assessment and management of mental illness or symptoms in individuals treated with dialysis in Canada are also limited, and no clinical practice guidelines exist. Several mental health resources for people living with dialysis are available, predominantly focused on psychoeducation and peer support. Despite increasing prevalence of mental health concerns by people treated with dialysis, mental health care remains underaddressed.Limitations:It is plausible that additional literature related to mental health assessment tools, interventions, resources, guidelines, and pathways exists that we did not find during our systematic search, especially in gray literature that was limited to one search engine. In addition, health care agencies or organizations may have developed other mental health resources, which may not be available on the Internet.

How to Support Parents of Infants and Young Children in Mental Health Care: A Narrative Review.

Objective: The aim of this narrative review is to gain insight into the appropriate intervention targets when parents of infants and young children suffer from psychopathology.Background: Psychopathology in parents is a risk factor for maladaptive parenting and is strongly related to negative cascade effects on parent-child interactions and relations in the short and long term. Children in their first years of life are especially at risk. However, in adult mental health care, this knowledge is rarely translated into practice, which is a missed opportunity for prevention.Methods: Electronic databases were searched for reviews and meta-analysis. In addition, sources were obtained via manual search, reference mining, expert opinion, and communications from conferences. In total, 56 papers, whereof 23 reviews and 12 meta-analyses were included.Results: Findings regarding targets of intervention were identified in different interacting domains, namely the parental, family, child, and environmental domains as well as the developing parent-child relationship. A “one size fits all” intervention is not appropriate. A flexible, tailored, resource-oriented intervention program, multi-faceted in addressing all modifiable risk factors and using different methods (individual, dyadic, group), seems to provide the best results.Conclusion: To address the risk factors in different domains, adult and child mental health care providers should work together in close collaboration to treat the whole family including mental disorders, relational, and contextual problems. A multi-agency approach that includes social services is needed.

Towards a Program Theory for Family-Focused Practice in Adult Mental Health Care Settings: An International Interview Study With Program Leaders.

Objectives: In several high-income countries, family-focused practice programs have been introduced in adult mental health care settings to identify and support children whose parents live with mental health problems. Whilst their common goal is to reduce the impact of parental mental illness on children, the mechanisms by which they improve outcomes in different systems and settings are less well known. This kind of knowledge can importantly contribute to ensuring that practice programs achieve pre-defined impacts.Methods: The aim of this study was to develop knowledge about relationships between contextual factors, mechanisms and impact that could inform a program theory for developing, implementing, and evaluating family-focused practice. Principles of a realist evaluation approach and complex system thinking were used to conceptualize the design of semi-structured in-depth interviews with individuals who led the implementation of programs. Seventeen individuals from eight countries participated in the study.Results: Interviewees provided rich accounts of the components that programs should include, contextual factors in which they operated, as well as the behavior changes in practitioners that programs needed to achieve. Together with information from the literature, we developed an initial program theory, which illustrates the interconnectedness between changes that need to co-occur in practitioners, parents, and children, many of which related to a more open communication about parental mental health problems. Stigma, risk-focused and fragmented health systems, and a lack of management commitment were the root causes explaining, for example, why conversations about parents' mental illness did not take place, or not in a way that they could help children. Enabling practitioners to focus on parents' strengths was assumed to trigger changes in knowledge, emotions and behaviors in parents that would subsequently benefit children, by reducing feelings of guilt and improving self-esteem.Conclusion: To our knowledge, this is the first research, which synthesizes knowledge about how family-focused practice programs works in a way that it can inform the design, implementation, and evaluation of programs. Stakeholder, who fund, design, implement or evaluate programs should start co-developing and using program theories like the one presented in this paper to strengthen the design and delivery of family-focused practice.

Mental health care for adults with mild intellectual disabilities: A retrospective database study

Abstract People with mild ID suffer more mental health disorders (MHD) than people without ID. Practitioners working in mental health services (MHS) indicate limited knowledge and experience to provide the care needed. Besides diagnosing MHD, identification of the ID itself is a challenge and not all people with a ID are recorded in the MHS as such. These factors contribute to insufficient care and can result in chronic, more difficult to treat MHD. For this study, all adult users of Dutch MHS between 2015 and 2017 were enrolled in MHS databases of Statistics Netherlands. Presence of mild ID was established by linking MHS data with social services and chronic care databases. Characteristics of new cases of MHC were analyzed and compared between patients with and without mild ID. Linking databases identified 11,374 MHC patients with mild ID, and 525,162 patients without ID. A substantial proportion of patients with mild ID did not have this characteristic noted in their MHS records (60.6%). Preliminary results showed people with mild ID were younger, were more often man, had different diagnostic profiles, required more crisis interventions, and more psychiatric hospital admissions compared to people without ID. In addition, people with a mild ID and no ID record in MHS received less treatment compared to both people with mild ID and a ID record, and people with no ID. According to these findings, the prevalence of MHD and provided care between people with and without a mild ID, in MHS deviated. The Mild ID is potentially under recognized among MHS patients. The findings are a first step towards improving mental healthcare for patients with ID.

When should we intervene in adolescent depression and with whom?

When should we intervene in adolescent depression and with whom?

Exercise interventions in child and adolescent mental health care: An overview of the evidence and recommendations for implementation.

The use of physical activity interventions in mental health care for adults has a large academic evidence base and numerous examples of real-world implementation. However, the use of physical activity within mental health care for children and young people (CYP) has received less attention to date. A narrative review was conducted to summarize the relevant literature in the area. Online databases were searched using terms synonymous with CYP, exercise, physical health, and mental health. Findings from existing systematic reviews, meta-analyses, meta-syntheses, and consensus statements were reviewed, and used alongside the authors' experience to inform clinical recommendations. We first discuss the importance of applying physical health interventions in early stages of mental illness for CYP to prevent physical comorbidities and premature mortality in the long term. We then provide a brief summary of the current evidence of the benefits of exercise interventions in CYP with mental illness. We then present our top five recommendations on the implementation of exercise interventions within CYP mental health care. The key conclusions from this suggest there is an increasingly strong evidence base for the benefits of using physical activity interventions to improve, prevent, and manage physical and mental health outcomes in CYP with mental illness. However, more work needs to be done to improve the evidence base, refine its implementation into standard mental health care, and develop strategies for large-scale dissemination of such interventions across various care and cultural contexts.

Prioritizing core components of successful transitions from child to adult mental health care: a national Delphi survey with youth, caregivers, and health professionals

Youth accessing mental health care often experience a disruption in care as they attempt to transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS). Few studies have evaluated interventions seeking to improve the experience and outcomes of CAMHS–AMHS transitions, in part due to lack of consensus on what constitutes best practices in intervention success. As such, the aim of this study was to engage patients, caregivers, and clinicians to prioritize core components of successful CAMHS–AMHS transitions which can be used in the design or evaluation of transition interventions. As such, a Delphi study was conducted to determine core components of successful CAMHS–AMHS transitions. Guided by the principles of patient-oriented research, three balanced expert panels consisting of youth, caregivers, and clinicians ranked and provided feedback on the importance and feasibility of core components of CAMHS-AMHS transitions. Components endorsed as feasible or important with ≥ 70% agreement from any panel moved to the next round. As a result, a list of 26 core components of CAMHS–AMHS transitions has been refined which can be used in the design, implementation, or evaluation of interventions intended to improve transition experiences and outcomes for youth in mental health care. Youth and families were engaged in an expert advisory role throughout the research process, contributing their important perspectives to the design and implementation of this study, as well as interpretation of the findings.

REFOCUS-PULSAR Recovery-Oriented Practice Training in Adult Primary Mental Health Care: Exploratory Findings Including From a Pretest-Posttest Evaluation.

Objectives: Australian general practitioners (GPs) are pivotal in mental health care. The REFOCUS-PULSAR (Principles Unite Local Services Assisting Recovery) primary care study aimed to improve personal recovery outcomes in adults with mental health problems consulting GPs.Design: Modified from an intended stepped-wedge cluster study, an exploratory (pre- and post-intervention) design employed cross-sectional surveys of patients consulting GPs.Setting: Eighteen primary care sites (clusters) in Victoria, Australia in 2013–2017.Participants: From 30 GPs recruited, 23 participated (76%), with 235 patient surveys returned from adults aged <75 years receiving mental health care.Intervention: A co-delivered face-to-face training intervention for GPs in recovery-oriented practice (ROP), with personal recovery a key focus, used multimedia, mnemonics, and targeted interview schedules to encourage ROP—with availability of support sessions for 1 year.Outcome Measures: Primary: the Questionnaire about the Process of Recovery full-scale score (outcome). Secondary: INSPIRE (experience), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and Kessler Psychological Distress Scale (K10) (outcomes). Other: General-practice-Users Perceived-need Inventory (experience).Results: Small positive significant effects indicated primary-outcome post-intervention improvements [t-test (233) = −2.23, p = 0.01], also improvement in two secondary outcomes (WEMWBS t(233) = −2.12, p = 0.02 and K10 t(233) = 2.44, p = 0.01). More patients post-intervention reported “no need” for further help from their GP; but in those reporting needs, there was greater unmet need for counseling.Conclusions: ROP implementation, internationally influential in specialist mental health care, here is explored in primary care where it has had less attention. These exploratory findings suggest better patient outcomes followed introducing GPs to ROP in routine practice conditions. Higher unmet need for counseling post-intervention reported by patients might be a sign of limited supply despite ROP facilitating better identification of needs. Challenges in project implementation means that these findings carry risks of bias and flag the importance establishing research infrastructure in primary care.Clinical Trial Registration: www.clinicaltrials.gov/, The Australian and New Zealand Clinical Trial Registry Identifier: ACTRN12614001312639.

Comparison of child and adult clinicians’ perceptions of barriers and facilitators to effective care transition

ABSTRACT Among individuals with mental illness, transition-age youth (TAY; age 16–25) have the lowest rate of treatment-seeking and the highest rate of premature exiting from treatment, at the exact time when their needs for mental health supports are greatest. This qualitative study provides insight into the perspectives of adult and child service clinicians regarding their perceived barriers and facilitators to reducing disengagement during the transition from child to adult mental health care. While child and adult clinicians agreed on many key barriers, they often disagreed on influencing factors. Child and adult clinicians had greater agreement among facilitators, particularly the need to provide greater service array flexibility during this transition.

Sustain and reinforce transition from child to adult mental health care in Switzerland: study protocol

Swiss Archives of Neurology, Psychiatry and Psychotherapy is an open access publication of EMH Swiss Medical Publishers Ltd. published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International.

New models of care in general practice for the youth mental health transition boundary.

Mental illness represents the highest proportion of disease burden for children and young people in the UK.1 However, despite this, young people can struggle to access timely and appropriate mental health care. One particular barrier to continuity of care occurs when young people reach the upper age limit (usually 18 years) of child and adolescent mental health services (CAMHS). If they require ongoing specialist support, their care should be transferred to an adult mental health service (AMHS), through a purposeful and planned transfer of care known as ‘transition’. However, only around a quarter of young people transition to AMHS,2 and in the absence of specialist adult mental health care, GPs often become involved in the young person’s care ‘by default’.3 Although GPs become responsible for the young person’s care after they leave CAMHS, they may not have the necessary skills and resources to manage complex mental health difficulties in young people. ### The role of the GP in transition The National Institute for Health and Care Excellence (NICE) transition guidance calls for a named GP to be part of the transition process, emphasising the role GPs can have in continuity of care.4 The guidance states that the person acting as the ‘named worker’ (who is responsible for coordinating transition for the young person) should proactively engage GPs in transition planning, allowing GPs to be involved in the young person’s mental health care at this crucial stage. At present, however, there is no known evidence to suggest that GPs are regularly involved in transition planning. This may be due to differing organisational cultures which prevent collaborative working; something which has been identified as a barrier …

Digital interventions in adult mental healthcare settings: recent evidence and future directions.

Internet and mobile-based interventions (IMI) can be used as online delivered forms of psychotherapeutic mental health treatments. These interventions can be an effective as well as time and cost-efficient treatment with the potential to scale up mental healthcare. In this review, we map implementation possibilities into routine mental healthcare settings and provide the most recent evidence. Fourteen articles on digital mental healthcare approaches published in the last 18 months were included. Despite the limited number, the studies provide evidence for the effectiveness of IMI in treating inpatients and outpatients with various disorders in different mental healthcare settings. IMI were investigated as stand-alone interventions, in combination with other treatment forms (blended-care), or as aftercare. Although there is encouraging evidence for the effectiveness of IMI in mental healthcare settings, several limitations have to be considered. The small number of studies conducted within the healthcare system, especially with inpatient samples, calls for more collaboration between researchers and clinical practitioners to unravel barriers and develop efficient protocols for the integration into routine care. Nonetheless, IMI are a promising tool for the endeavour of closing the treatment gap and should, therefore, be further explored in varying settings.