Care-based Mental Health Research Articles

Perceptions of Mental Health and Mental Health Care in Luxembourg: A High-Income Country

AbstractMental health care in high-income countries can have various rates of usage due to differences in accessibility, modality of psychotherapy, and potential stigma surrounding mental health (Alonso et al., 2004). This study aimed to explore perceptions of mental health and mental health care, stigma for mental illness, and perceived change in mental health due to COVID − 19 pandemic in a high-income country with relatively easy access to basic mental health care. An anonymous survey was sent to individuals who are 18 years and older and resident of Luxembourg, a small country in Europe (N = 56). Participants were asked a series of open-ended and forced choice questions. Descriptive statistics were calculated for forced-choice questions and inductive content analysis was used to analyze the open-ended responses. Participants defined mental health in a variety of different ways, and a majority reported receiving mental health services. There was no significant difference in participants’ ratings of mental health before and during the COVID-19 pandemic. Mental health professionals were relatively easy to find and were considered somewhat helpful, though participants also reported some stigma towards mental illness. Benefits and challenges of in-person and virtual therapy showed points of crossover and potential for further research. The current findings inform the broader literature on mental healthcare with implications for improving care in high-income countries.

Learning and achieving basic mental health competence in placement studies with the support of a tool: A qualitative study of student nurses’ experiences

BackgroundLearning basic mental health care competence is often challenging for the bachelor of science student nurses, and many lack basic mental health care competence to ensure safe and confident mental health care practice. Mental health assessment is an integrated part of this competence. ObjectiveThe objective of this study was to explore and describe in depth how student nurses experience learning and achieving basic mental health competence while on mental health placement with the support of a learning tool. DesignAn explorative and descriptive qualitative design was conducted to gain insight on how student nurses experienced learning basic mental health competence when on placement. SettingA diversity of mental health placement settings in which student nurses were involved with patient care or welfare were approached; general psychiatric wards (n = 2), psychiatric ward for elderly people (n = 1), community mental health in-patient facilities (n = 2) and unconventional placements in the community (n = 9). Unconventional placements are a diversity of non-clinical service contexts. ParticipantsThe participants comprised student nurses in their 3rd and final year while on mental health placement. Potential participants received information from course coordinators, the online learning platform, and from teachers in plenary. Using purposive sampling, 14 student nurses were recruited. MethodsIndividual semi-structured interviews were conducted online and in person at two campuses of one university in Norway between August 2020 and December 2021. The interviews were transcribed and thematically analysed as described by Braun and Clarke. ResultsStudents expressed insecurity in a new clinical context. They engaged in new learning situations and realized the diversity of nursing practice. Unconventional placements were described as challenging contexts for learning basic mental health care competence. ConclusionsThis qualitative study provided insight into how student nurses experience learning mental health assessment, and gaining relational, communicative, and ethical competence while on placement. Students revealed their insecurities and challenges in learning in a new context. Awareness of clinical learning opportunities on placement when preparing student nurses to learn basic mental health competence may help improve their confidence.

Healthcare utilization patterns of individuals with depression after national policy to increase the mental health workforce in primary care: a data linkage study

BackgroundThe deployment of the mental health nurse, an additional healthcare provider for individuals in need of mental healthcare in Dutch general practices, was expected to substitute treatments from general practitioners and providers in basic and specialized mental healthcare (psychologists, psychotherapists, psychiatrists, etc.). The goal of this study was to investigate the extent to which the degree of mental health nurse deployment in general practices is associated with healthcare utilization patterns of individuals with depression.MethodsWe combined national health insurers’ claims data with electronic health records from general practices. Healthcare utilization patterns of individuals with depression between 2014 and 2019 (N = 31,873) were analysed. The changes in the proportion of individuals treated after depression onset were assessed in association with the degree of mental health nurse deployment in general practices.ResultsThe proportion of individuals with depression treated by the GP, in basic and specialized mental healthcare was lower in individuals in practices with high mental health nurse deployment. While the association between mental health nurse deployment and consultation in basic mental healthcare was smaller for individuals who depleted their deductibles, the association was still significant. Treatment volume of general practitioners was also lower in practices with higher levels of mental health nurse deployment.ConclusionIndividuals receiving care at a general practice with a higher degree of mental health nurse deployment have lower odds of being treated by mental healthcare providers in other healthcare settings. More research is needed to evaluate to what extent substitution of care from specialized mental healthcare towards general practices might be associated with waiting times for specialized mental healthcare.

Incentivizing community health workers for scaling up mental health care in rural communities in India: A critical look at principles that work.

Given the low availability of trained mental health professionals, there is evidence on task sharing where basic mental healthcare can be provided by trained community health workers (CHWs). A potential way to reduce the mental health care gap in rural and urban areas in India is to utilize the services of community health workers known as Accredited Social Health Activists (ASHAs). There is a paucity of literature that have evaluated incentivizing non-physician health workers (NPHWs) vis-à-vis maintaining a competent and motivated health workforce especially in the Asia and Pacific regions. The principles around what works and does not work in terms of a mix of incentive packages for CHWs, while providing for mental healthcare in rural areas have not been adequately evaluated. Moreover, performance-based incentives which are receiving increasing attention from health systems worldwide, though evidence on the effectiveness of these incentives in Pacific and Asian countries is limited. CHW programs that have shown to be effective rely on an interlinked incentive framework at the individual, community, and health system levels. Drawing learnings from the past eight years in implementing the SMART (systematic medical appraisal, referral and treatment) Mental Health Program in rural India, we critically examine some of the emerging principles in incentivizing ASHAs while scaling up mental healthcare in communities using a systems approach.

Predicting Undesired Treatment Outcomes With Machine Learning in Mental Health Care: Multisite Study.

Predicting which treatment will work for which patient in mental health care remains a challenge. The aim of this multisite study was 2-fold: (1) to predict patients' response to treatment in Dutch basic mental health care using commonly available data from routine care and (2) to compare the performance of these machine learning models across three different mental health care organizations in the Netherlands by using clinically interpretable models. Using anonymized data sets from three different mental health care organizations in the Netherlands (n=6452), we applied a least absolute shrinkage and selection operator regression 3 times to predict the treatment outcome. The algorithms were internally validated with cross-validation within each site and externally validated on the data from the other sites. The performance of the algorithms, measured by the area under the curve of the internal validations as well as the corresponding external validations, ranged from 0.77 to 0.80. Machine learning models provide a robust and generalizable approach in automated risk signaling technology to identify cases at risk of poor treatment outcomes. The results of this study hold substantial implications for clinical practice by demonstrating that the performance of a model derived from one site is similar when applied to another site (ie, good external validation).

Occupational physicians dealing with mental health: between employee and company interests: a qualitative study

BackgroundOccupational health physicians are increasingly confronted with mental health issues at their workplace. Facing them, most of them feel insecure and not sufficiently trained. Employee’s mental well-being depends at the same time on individual and significantly on organizational variables. This complicates the physician’s position, since they have to serve many interests. The focus of the present study is to investigate what difficulties occupational health physicians face and how organizational culture and management influence their work.MethodsInterviews were conducted with N = 25 physicians as part of a training for basic mental health care. Interviews were interpreted using qualitative content analysis.ResultsWorking with mentally ill employees was difficult for the physicians interviewed. Many felt insecure managing and preventing mental health issues. A need for further education was observed. Environmental factors (organizational culture, management) have a strong impact on the work of an occupational health physician and highlight its systemic dimension. Even though many of our participants report a meanwhile more open attitude towards mental disorders at their workplace, on the level of direct contact to the management prevail descriptions of little acceptance and a high priority of economic outcomes.ConclusionsMore education on topics of mental health is needed for occupational health physicians. Future trainings should consider the intertwined nature of their work and enable them in dealing consciously with other actors in the company. For enhancing employee’s mental well-being occupational health physicians could be granted a strengthened position in companies or be supported through more exchange with colleagues in other companies.

Perceptions of Community Health Workers (CHW) on barriers and enablers to care for people with psychosis in rural Mozambique: findings of a focus group discussion study using the Capability, Opportunity, Motivation and Behaviour framework (COM-B framework)

BackgroundPsychotic disorders contribute significantly to the global disease burden by causing disability, impaired quality of life, and higher mortality in affected people compared with the general population. In rural settings, where there is limited or no access to healthcare, individuals living with psychotic disorders often seek support from Community Health Workers (CHWs). However, little is known about what CHWs know about psychosis and how they manage such cases. This study aimed to explore the CHWs perception of psychosis and their experiences and beliefs about the factors that might enable or hinder care-taking for patients with psychosis in rural settings in Mozambique.MethodsA qualitative study was conducted in rural districts of Maputo Province, a southern region of Mozambique, using six focus group discussions with participation of 79 CHWs. Thematic analysis was used informed by the Capabilities, Opportunities, Motivation and Behaviour framework (COM-B).ResultsNine primary themes were identified. Overall, CHWs perceived psychosis as treatable medical conditions and held a positive attitude about being part of the care-taking process of patients with psychosis in rural settings. Partnerships with key-stakeholders such as traditional healers, health care workers, and families, were perceived by CHWs as enablers to improve access to care in rural areas. However, stigma, myths, and lack of competencies to treat people with psychosis were perceived by CHWs as barriers for appropriate care.ConclusionCHWs, with adequate support, could play an important role in the care of patients with psychosis in rural settings, including identifying patients requiring care and referring them to appropriate healthcare professionals, and following up medicated patients with psychosis. Training of CHWs should consider inclusion of basic mental health care competencies.

Impact of COVID-19 social distancing measures on routine mental health care provision and treatment outcome for common mental disorders in the Netherlands.

ObjectiveThe uptake of digital interventions in mental health care (MHC) has been slow, as many therapists and patients believe that in‐person contact is essential for establishing a good working relationship and good outcomes in treatment. The public health policies regarding social distancing during the coronavirus disease‐2019 (COVID‐19) pandemic forced an abrupt transformation of MHC provisions for outpatients: Since mid‐March 2020, nearly all in‐person contact was replaced with videoconferencing. The COVID‐19 crisis offered a unique opportunity to investigate whether MHC with videoconferencing yields inferior results as compared to in‐person interventions.MethodIn a large urban MHC facility in the Netherlands, measurement‐based care is routine practice. Outcome data are regularly collected to support shared decision making and monitor patient progress. For this study, pretest and post‐test data were used to compare outcomes for three cohorts: treatments performed prior to, partially during and entirely during the COVID‐19 lockdown. Outcomes were compared in two large data sets: Basic MHC (N = 1392) and Specialized MHC (N = 1040).ResultsTherapeutic outcomes appeared robust for COVID‐19 conditions across the three cohorts: No differences in outcomes were found between treatments that were conducted during lockdown compared to in‐person treatments prior to COVID‐19, or treatments which started in‐person, but needed to be continued by means of videoconferencing.DiscussionVideoconferencing care during the COVID‐19 pandemic had similar outcomes compared to traditional in‐person care. These real‐world results corroborate findings of previous randomized controlled studies and meta‐analyses in which videoconferencing and in‐person care has been directly compared in terms of clinical effectiveness.

Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care.

Mental health care must improve in this country. With the worsening shortage of psychiatrists and other mental health professionals, the next generation of physicians in primary care will need to be better trained in mental health care. We estimate the direct cost of implementing an evidence-based Train-the-Trainer (3T) program to disseminate mental health training to allopathic medical school faculty; once trained, faculty can teach a much-enhanced curriculum of mental health care to medical students and residents. A combination of published standardized unit costs and an activity-based costing approach is used to estimate the direct costs (labor and nonlabor) for implementing the 3T program. The estimated direct cost of implementing the 3T program at one prototypical school, including the 12-month start-up period (1.1 million) and 18-month rollout period (8.6 million), is ∼9.7 million dollars. Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated.

The Ethical Conundrums of “Precision Psychiatry”

The Ethical Conundrums of “Precision Psychiatry”

Scaling-up a new socio-mental health service model in Iran to reduce burden of neuropsychiatric disorders: an economic evaluation study

BackgroundThe integration of core packages of mental health care into routine primary health care has been introduced as an effective way to achieve universal health coverage in mental health care. Based on the transition of mental health care in Iran, from introducing basic mental health care in PHC to the experience of community-based mental health centers for urban areas, a new socio-mental health service model has been so far proposed. This study aimed to estimate the impact of scaling-up the new socio-mental health model at the national level as well as its associated costs.MethodsThis study was a cost-consequence analysis following One Health Tool methodology. The data required for the study were collected in the first quarter of the year 2020 with a time horizon from 2020 to 2030. The selected metric for summarizing health effects is healthy life years gained. Resources used in terms of drug and supply, staff salaries and outpatient visits were documented and associated costs were subsequently estimated in order to estimate the average cost of each intervention per case.ResultsThe health impacts are calculated in terms of healthy life years gained for 2020–2030, after adjusting the prevalence and incidence rates for each disorder. In total, 1,702,755 healthy life years were expected to be gained. Considering total 1,363,581,654 US dollars cost in base case scenario, each healthy life years gained will cost around 801 US dollars. Based on the WHO criteria for cost-effectiveness threshold, all of the values ranged from 724 to 1119 US dollars obtained through eight different scenarios were considered as cost-effective given the GDP per capita of 5550 US dollars for Iran in 2018.ConclusionsMental health budget in Iran equals to about three percent of total health expenditure while the mental health cost per capita is estimated to be 1.73 US dollar which are relatively low considering the share of the MNS disorders in the national burden of diseases. The results of current study showing the cost of 16.4 US dollar per capita for scaling up this comprehensive mental health service model can convince high-level policy-makers to increase the share of mental health budget accordingly. The present study demonstrated that the cost in this new socio-mental services model is not substantial compared with GDP per capita of Iran.

A Study on Prevalence and Factors Associated with Depression among Elderly Residing in Tenements Under Resettlement Scheme, Kancheepuram District, Tamil Nadu.

Background:Mental disorders have got high prevalence and low priority among the elderly in most of the countries worldwide, of which depression being the most common treatable condition. The causes for elderly depression are multifactorial and preventable.Objective:The aim of this study is to estimate the prevalence of depression and to assess the factors associated with depression among the elderly age.Materials and Methods:A cross-sectional study was conducted among participants more than 60 years of age residing in tenements under resettlement scheme in Semmenchery, Kancheepuram district, Tamil Nadu with a sample size of 184. Systematic sampling method was adopted to collect data at participants door step. A predesigned, pretested questionnaire was used to assess the factors associated with depression, and the Geriatric depression scale-30 was used to assess depression. The data were analyzed using SPSS and Chi-square <0.05 was considered significant.Results:The overall prevalence of depression was 35.3%. The factors such as female gender, educational status, occupation, type of family, financial dependency, history of depression, smoking and medical factors such as hypertension, cardiac disease, and chronic kidney disease and life events like conflict in family, unemployment, and financial problem were statistically significant (P < 0.05).Conclusion:Loss of spouse, financial dependency, neglected care, lack of awareness about the disease were found to be barriers in reaching basic mental health care for the elderly. Depression remains one of the main causes of DALY, especially among elders. National Program for Health care of elderly provides doorstep services, so incorporation of depression screening into that can impart the effects of depression on quality of life and DALY.

The institutionalization of mental health and psychosocial support in emergencies in Indonesia

The paper probes how Mental Health and Psychosocial Support for emergencies (MHPSS) has been institutionalized in a disaster-prone country. Using Indonesia as a case study, the article lays down the various MHPSS-related institutions and systems (legal frameworks, policies, processes, and programs) that were constituted at different levels of governance in Indonesia as part of its disaster management structures. It examines how these institutions and systems were made to operate in the Central Sulawesi and Nusa Tenggara Barat (NTB) disasters of 2018. Furthermore, factors that facilitated or hindered the effective functioning of the MHPSS system are discussed. The findings of this research are based on secondary data and primary data collected through interviews and focus group discussions with various national and local government and non-government stakeholders involved in disaster response, including field visits in the two provinces. The paper contends that the Indonesian Government has established necessary national disaster management institutions and structures with local counterparts, where MHPSS structures have been integrated. It also discusses crucial intervention programs delivered to survivors of the two provincial disasters, which the paper asserts conform to the integrated support systems prescribed by the IASC that include basic services and security, community and family support (family reunification, psychosocial support, and community rituals) focused non-specialized services (PFA, psychological intervention, and basic mental health care), and specialized services (referral services to clinical and non-clinical service providers). Lastly, the paper argues that a confluence of administrative, logistical, organizational, resource, supply, human resource, and contextual factors have either hindered or facilitated the functionality of the MHPSS systems in place, which explains the varying levels of efficiency of the MHPSS responses in the two provinces.

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Két városi rendőrkapitányság szervezetpszichológiai vizsgálata 2018-ban

Jelen írás két olyan szervezetpszichológiai vizsgálatot mutat be, amelyek egyegy vidéki városi rendőrkapitányságot érintettek 2018-ban. A vizsgálatok vezetői kezdeményezésre indultak, az adott szervezeti elemek esetében a kommunikáció és a hangulat feltérképezését célozták, illetve a megnövekedett fluktuáció hátterének feltárására irányultak. A vizsgálatoknál interjúk és kérdőívek kerültek felvételre, a második vizsgálat esetében a rendőrkapitányság minden egyes dolgozójának interjúzására és kérdőívezésére került sor. Így az eredményekből a hangulat, a kommunikáció, a kapcsolati minőség (bizalom, következetesség, visszajelzések, együttműködés), a teljesítmény, a fluktuáció és az értékrend komplex képe rajzolódik ki a kapitányságon, amelynek hátterében számos társadalmi jelenség felfedezhető, mint például az új generációk (Y és Z) megjelenése a munkaerőpiacon. A rendőrségi pszichológiai alapellátás adta lehetőségeknek köszönhetően azonban nemcsak a két szervezeti elemet jellemző keresztmetszeti képet mutathatja be az írás, hanem a rendőrség szervezetét ma jellemző szervezetpszichológiai megfontolásokat is megfogalmaz. Megállapítja, hogy a szervezetben a hangulatot jellemzően két, szervezetet átható érzés befolyásolja, ezek pedig a szervezeti igazságtalanság érzet, illetve a dolgozók által megélt negatív emberszemlélet. Megoldásként humánstratégiai átalakítások javasolhatók a szervezet meggyengült megtartó erejének növelésére. A közösség, a társas támogatás, a jó kapcsolatok azok, amelyek a kötődést jelentik jelenleg a szervezetben a dolgozók számára, ezért ezek támogatása elengedhetetlen.

Mental health services in Cambodia: an overview.

Mental health services in Cambodia required rebuilding in their entirety after their destruction during conflict in the 1970s. During the late 1990s there was rapid growth and development of professional mental health training and education. Currently, basic mental healthcare is available primarily in urban areas and is provided by a mixture of government, non-government and private services. Despite the initial rapid growth of services and the development of a national mental health strategy in 2010, significant challenges remain in achieving an acceptable, standardised level of mental healthcare nationally.

Systematic client feedback to brief therapy in basic mental healthcare: study protocol for a four-centre clinical trial

IntroductionThe Partners for Change Outcome Management System (PCOMS) is a client feedback-system built on two brief visual analogue self-report scales. Prior studies of PCOMS have found effects varying from significant...

Significance of mental health legislation for successful primary care for mental health and community mental health services: A review.

BackgroundMental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness.AimsTo provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethodA qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted.ResultsIn many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed.ConclusionMental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

Prioritizing rural and community mental health in India: Now, more than Ever Before

Community mental health care in India started in the 1970s. It was long felt that integrating mental health with primary care by training and supporting primary health care personnel to deliver basic mental health care was the best way to provide care for those in need of mental health services in the developing countries. This has been recently echoed by an international consortium as well. The national mental health program, and later the district mental health program, has been right and ambitious steps in this direction. However, effective coverage for severe mental disorders and epilepsy continues to be very low. While there are vast variations across regions of the country, the highest treatment gaps are in rural areas because of inequities in the distribution of mental health resources and variable implementation of mental health program across states. We now know what to do, but we have to begin doing it effectively. It is indeed high time that we prioritize rural and community mental health in India.

Promotion of Human Rights in Mental Health – Youth’s Perspective

There exists a global human rights emergency in mental health. The stigma, myths and misconceptions associated with mental disorders negatively affect the lives of people with mental disorders leading to denial of even the most basic human rights. Worldwide, people with mental disabilities experience an ambit of human rights violations. They are denied access to basic mental health care and treatment. They are not only discriminated against and stigmatized but are also subjected to abuse in both mental health facilities and the community. Several violations in community-based mental health care go unreported. Victims of discrimination are particularly vulnerable to restrictions in economic, social and cultural rights that make it difficult to be integrated into mainstream society. A sense of alienation can affect a person’s dignity and self-esteem, which is detrimental to one’s well-being. A qualitative approach was employed to understand the role of youth in promoting and protecting human rights in mental health. A Focus Group Discussion was done on a sample of 10 respondents who willing first BA students of Psychology – 2 males and 8 females aged 18–20 years. Results were analyzed using narratives. The objectives were to understand the threats to dignity in mental health care and ways to promote it. It was expressed that mental health inequalities lie even outside the health sector and thus inter-sectoral action is required to redress the issue. It was advocated to raise mental health issues on the agenda of political, religious and community arenas. Health facilities ought to be person-centred, privacy maintained, equitable and equal. The study has implications for mental health professionals to be more humane and ethical in practice and improve quality health care. Besides, mental health literacy should be imparted at various levels of education.