Collaborative Mental Health Care Research Articles

Association Between Adverse Childhood Experiences and Adverse Pregnancy Outcomes.

To examine the association between adverse childhood experiences and adverse pregnancy outcomes. This cohort study included individuals who enrolled in a perinatal collaborative mental health care program (COMPASS [the Collaborative Care Model for Perinatal Depression Support Services]) between 2017 and 2021. Participants completed psychosocial self-assessments, including an adverse childhood experiences screen. The primary exposure was adverse childhood experiences measured by the ACE (adverse childhood experience) score, which was evaluated as a dichotomized variable, with a high ACE score defined as greater than three. Secondary analyses used the ACE score as a continuous variable. Adverse pregnancy outcomes including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and small-for-gestational-age (SGA) births were abstracted from the electronic health record. Bivariable and multivariable analyses were performed, including mediation analyses. Of the 1,274 women with a completed adverse childhood experiences screen, 904 (71%) reported one or more adverse childhood experiences, and 290 (23%) reported a high ACE score (more than three adverse childhood experiences). Adverse childhood experience scores were not associated with gestational diabetes or SGA births. After controlling for potential confounders, individuals with high ACE score had 1.55-fold (95% CI 1.06-2.26) increased odds of having hypertensive disorders of pregnancy and 2.03-fold (95% CI 1.38-2.99) increased odds of preterm birth. Each point increase in ACE score was not associated with a statistically increased odds of hypertensive disorders of pregnancy (adjusted odds ratio [aOR] 1.07, 95% CI 0.99-1.15); however, each additional point on the adverse childhood experiences screen was associated with increased odds of preterm birth (aOR 1.13, 95% CI 1.05-1.22). Mediation analyses demonstrated tobacco use, chronic medical problems, and obesity each partially mediated the observed association between high ACE scores and hypertensive disorders of pregnancy. Having chronic medical comorbidities partially mediated the observed association between high ACE scores and preterm birth. One in four individuals referred to a perinatal mental health program who were pregnant or postpartum had a high ACE score. Having a high ACE score was associated with an increased risk of hypertensive disorders of pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.

Adults with intellectual disabilities and mental health disorders in primary care: a scoping review.

BackgroundGPs are increasingly confronted with patients with both intellectual disabilities (ID) and mental health disorders (MHD). Currently, the care provided to these patients is found to be insufficient, putting them at risk of developing more severe MHD. Improving the quality of GP care will improve the whole of mental health care for this patient group. Therefore, an overview of the content and quality of care provided to them by the GP may be helpful.AimTo provide an up-to-date literature overview of the care provided by GPs to patients with ID and MHD, identify knowledge gaps, and inform research, practice, and policy about opportunities to improve care.Design and settingScoping review.MethodPubMed, PsycINFO, EMBASE, and grey literature were searched for publications concerning primary care and patients with ID and MHD. Selected publications were analysed qualitatively.ResultsOne hundred publications met the inclusion criteria. Five overarching themes were identified: GP roles, knowledge and experience, caregiver roles, collaboration, and a standardised approach. The results show GPs’ vital, diverse, and demanding roles in caring for patients with both ID and MHD. GPs experience problems in fulfilling their roles, and gaps are identified regarding effective GP training programmes, applicable guidelines and tools, optimal collaborative mental health care, and corresponding payment models.ConclusionThe improvement required in the current quality of GP care to patients with ID and MHD can be achieved by bridging the identified gaps and initiating close collaborations between care professionals, policymakers, and organisational managers.

Timing of perinatal mental health needs: data to inform policy

The policies pertaining to perinatal healthcare should be informed by medical needs. The windows of standard obstetrical care and mandated Medicaid coverage eligibility typically end approximately 8 weeks postpartum, even though women may have perinatal health concerns, including suicidal ideation, which are identified beyond this period. To evaluate the timing of mental health needs across the perinatal period with a focus on how frequently the initial referral and suicidal ideation occur outside of standard obstetrical care windows. This retrospective cohort study included all women during pregnancy or up to one year postpartum referred to a perinatal mental health collaborative care program (COMPASS) between September 2017 and September 2019. The timing of initial referral to COMPASS was identified, with women referred postpartum categorized by whether the referral was made after 8 weeks postpartum. The characteristics of the women were compared according to the timing of the initial mental health referral with receiver operating characteristic curves to identify whether patient characteristics could accurately classify women whose initial mental health needs were not recognized until after 8 weeks postpartum. Similarly, the assessment of suicidal ideation, either at or after referral, was ascertained, with the evaluation of the timing at which suicidal ideation was first expressed. Of 1421 women referred for mental healthcare during the study period, 774 (54%) were initially referred antenatally and 647 (46%) were initially referred postpartum. The women who were referred antenatally exhibited no clustering in the timing of referral. Of the women referred postpartum, 203 (31%) were referred after 8 weeks postpartum. Sociodemographic and medical characteristics were unable to accurately classify which women were referred for mental health care after 8 weeks postpartum (area under the curve, 0.64; 95% confidence interval, 0.58-0.68). A total of 215 (16%) women reported suicidal ideation at or after the time of initial referral: 129 (17%) antenatally and 86 (14%) postpartum. The incidence of suicidal ideation was not significantly different before vs 8 weeks postpartum. Perinatal mental health needs, including suicidal ideation, are often first recognized beyond 8 weeks postpartum. These data should be taken into consideration in policymaking discussions pertaining to the approach to medical care continuity and postpartum healthcare coverage.

Racial, ethnic differences in complementary and integrative health use among adults with mental illness: Results from the 2017 National Health Interview Survey

AbstractThe purpose of this study was to examine the patterns of complementary and integrative health (CIH) use among adults with a racial/ethnic minority background and a mental illness. A secondary data analysis of 2017 National Health Interview Survey (N= 793) was conducted using chi-square, multivariate logistic regression, and multinomial logistic regression. Overall, Black/African Americans and Hispanic/Latinx groups remained the least proportional of CIH therapies utilization. Being a male, Black/African American or Latinx/Hispanic and had work experience were predictors of the least use of the CIH therapies. Research is needed to bridge the gaps on the CIH use among a racial/ethnic minority with mental illness and to enhance the equitable and collaborative mental health care in the community.

Understanding interprofessional team delivery of patient-centered care: a qualitative secondary analysis

ABSTRACT Primary Care providers are expected to deliver patient-centered care (PCC) within teams; however, PCC tends to be studied within the provider-patient dyad, often to the exclusion of interprofessional team relationships. The purpose of this study was to explore how PCC is understood in the context of inter-provider relationships within Collaborative Mental Health Care teams. Previously collected data formed the basis of a qualitative secondary analysis using constructivist grounded theory. Focus group transcripts from six teams were analyzed using constant comparison. Coding, memoing, and diagramming were used to construct categories and themes. Having worked together over time, these teams developed a shared identity termed the Collective in this analysis. We define this social entity including antecedent conditions, the cultural milieu of the Collective, and provider-perceived outcomes. We further detail how these providers understood PCC as a team-delivered practice including the processes of coming together for a more complete picture, delivering the same message, and managing complexity together. We argue that practice settings supporting relationship development between providers, in addition to with the patient, may be essential to team delivery of PCC.

Improving Payment for Collaborative Mental Health Care in Primary Care.

There is strong evidence supporting implementation of the Collaborative Care Model within primary care. Fee-for-service payment codes, published by Current Procedural Terminology in 2018, have made collaborative care separately reimbursable for the first time. These codes (ie, 99492-99494) reimburse for time spent per month by any member of the care team engaged in Collaborative Care, including behavioral care managers, primary care providers, and consulting psychiatrists. Time-based billing for these codes presents challenges for providers delivering Collaborative Care services. Based on experience from multiple health care organizations, we reflect on these challenges and provide suggestions for implementation and future refinement of the codes. Further refinements to the codes are encouraged, including moving from a calendar month to a 30-day reimbursement cycle. In addition, we recommend payers adopt the new code proposed by the Centers for Medicare and Medicaid Services to account for smaller increments of time.

Depression treatment in Germany \u2013 using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy

BackgroundSocieties strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general practitioner (GP) program, improved guideline adherence or need-oriented and timely access to psychotherapy compared to usual care (UC).MethodsWe conducted a retrospective observational cohort study based on health insurance claims data. After we identified patients with depression who were on sick leave due to a mental disorder in 2015, we applied entropy balancing to adjust for selection effects and employed chi-squared tests to compare guideline adherence of the received treatment between PNP, the GP program and UC. Subsequently, we applied an extended cox regression to assess need-orientation by comparing the relationship between accumulated sick leave days and waiting times for psychotherapy across health plans.ResultsN = 23,245 patients were included. Regarding guideline adherence, we found no significant differences for most severity subgroups; except that patients with a first moderate depressive episode received antidepressants or psychotherapy more often in UC. Regarding need-orientation, we observed that the effect of each additional month of sick leave on the likelihood of starting psychotherapy was increased by 6% in PNP compared to UC.Irrespective of the health plan, we found that within the first 12 months only between 24.3 and 39.7% (depending on depression severity) received at least 10 psychotherapy sessions or adequate pharmacotherapy.ConclusionsThe PNP contract strengthens the relationship between sick leave days and the delay until the beginning of psychotherapy, which suggests improvements in terms of need-oriented access to care. However, we found no indication for increased guideline adherence and – independent of the health plan – a gap in sufficient utilization of adequate treatment options.

Use of problem based learning activity to improve attitudes regarding inter-professional collaborative teamwork in mental health nursing students: An evaluation study

Inter-professional collaboration results in improved processes, quality, cost-effectiveness, and outcomes in health care. Despite benefits of collaboration, little is known about effective nursing education approaches in collaboration. A pre-test, post-test brief longitudinal educational evaluation design was implemented utilizing a teamwork attitudes questionnaire to explore thirty-six Midwestern United States undergraduate nursing students' attitudes about collaborative care. An electronic educational module about collaborative nursing practice was used. Also, participants developed visual representations (maps) of collaborative care teams utilizing reverse case-study approach. The TAQ tool demonstrated significantly improved students' valuation of teamwork after the electronic module activity (t = 5.976, p = 0.000) and increased the identification of need for administrative support for effective teamwork (t = 33.53, 0.000). Collaborative team map drawings demonstrated that patient's frequently fail to identify themselves (75%) and social workers (70%) as part of their care team. Patients (58.3%) and students (77.8%) however, frequently identified family members as important to care. Further study should identify how nurses can fully engage and sustain involvement of family members and social workers in collaborative mental health care. Benefit in student nurses' attitudes about teamwork was found after a brief educational learning module about collaboration.

Psychotherapists' perspectives on collaboration and stepped care in outpatient psychotherapy-A qualitative study.

ObjectiveStepped and collaborative care with outpatient psychotherapy as one treatment step is guideline-recommended for mental health care. To date, the experiences and evaluation of psychotherapists regarding collaboration and stepped care have been neglected. In order to improve collaborative mental health care, this qualitative study aimed at identifying psychotherapists’ perspectives and needs within collaboration and stepped care.MethodsSemi-structured qualitative interviews with 20 German outpatient psychotherapists were conducted and analyzed applying thematic analysis. The analysis was realized in a recursive process to first identify themes and then relate these themes back to the research questions with regard to collaboration and stepped care.ResultsCollaboration mainly took place in small networks, with general practitioners and psychiatrists as the most important partners and psychotherapists wishing to intensify collaboration. Main barriers for collaboration were seen in deficient resources and remuneration and in a perceived lack of esteem by other medical specialties. Stepped care was appreciated for intensified collaboration and low-threshold access to care. Doubts were cast on its implementation within current health care conditions, worries concerned a primacy of economic principles instead of patient-orientation. Among further needs, psychotherapists demanded increased knowledge about psychotherapy, especially among general practitioners.ConclusionPsychotherapists expressed ambivalent attitudes towards stepped and collaborative care, substantially influenced by health care conditions and the perceived own standing among care providers. Psychotherapists’ needs within stepped care comprise intensified collaboration, sufficient time, personal and financial resources for collaboration and opportunities for a constructive interprofessional dialogue.

Contributions of activity ergonomics to the design of an electronic health record to support collaborative mental care of children and youth: Preliminary results.

The use of electronic health records (EHR) is related to the improvement of service quality and care coordination. The design of this platform generally focuses on the individual use of the system and does not integrate the specific needs of workers to provide support for collaborative activities. The study investigated how activity ergonomics (AE) contributed to improve the design of an EHR that supports the collaborative mental health care of children and youth. This qualitative study, based on the theoretical framework of AE, used individual and group interviews and document analysis as research procedures. The data collection occurred between March and September 2017 in Rio de Janeiro, Brazil. The study highlighted the following points: the characteristics that marked the different perceptions of workers regarding the use of a communication tool for collaborative care; the problems related to spreadsheet usability; and the desirable attributes that should be considered in the conception of a new EHR. The research indicated that AE favors improving the design of an EHR by incorporating the work dimension into the project.

Establishing views of traditional healers and biomedical practitioners on collaboration in mental health care in Zanzibar: a qualitative pilot study

BackgroundThis qualitative pilot study aimed to establish views of traditional and biomedical practitioners towards collaboration between the two sectors on the treatment of people with mental illness in Zanzibar, Tanzania.MethodsSix traditional healers (known as “waganga” in Swahili) and six nurses working in government secondary mental health services were invited to participate in a series of focus group discussions (FGDs). Two sets of FGDs took place approximately seven weeks apart. In each set, FGDs were conducted with traditional healers only, nurses only, and finally nurses and traditional healers together. FGDs were conducted in Swahili, audio-recorded and then translated to English by an independent translator and coded thematically using NVivo software.ResultsAll participants expressed that they were in favour of collaboration between traditional and biomedical practitioners on mental healthcare. Opinions varied regarding what form this collaboration should take. For many nurses and healers, there was acknowledgement of the role of the other group in providing treatment for people with mental illness, with support for the idea of bi-directional referrals between the two sectors. For some nurses, the value of collaboration would be purely in the education of traditional healers in the recognition of mental illness, with subsequent referral to biomedical services. For some traditional healers, the idea of collaboration seemed to appeal in part because of a perceived opportunity to learn additional skills from biomedical practitioners. Both categories of participant expressed a belief that patients possessed by a jinn (a spirit) or those that had been bewitched needed treatment by traditional healers. On the other hand, those with what participants considered to be “mental illness” needed treatment at the hospital clinic. However, some nurses felt that that traditional healers might be able to provide helpful treatment for mental illness, as well as those suspected to be affected by jinn or witchcraft. There was agreement on the need to establish clear referral pathways between the two service providers. The creation of an office for traditional healers at the hospital was an area where there was disagreement among participants.ConclusionsWe conclude that there is a positive view of collaboration among traditional healers and nurses who participated, and a willingness to work towards actual collaboration. The results suggest that views vary as to what form this collaboration should take, with opinions differing between nurses, as well as between traditional healers. Additional work is needed in order to further explore the nature of potential collaboration and extend the research to the wider population of traditional and biomedical practitioners in Zanzibar, to include primary health care workers.

Overcoming “You Can Ask My Mom”: Clinical Arts-Based Perspectives to Include Children Under 12 in Mental Health Research

As research with children (rather than research on children) gains popularity and researchers adapt methods to include children’s voices, continual reflection on the research methods themselves is needed. In this article, we explore the relevance of playing and drawing in qualitative research interviews to include and represent the voice of children under 12 years of age, particularly in the field of mental health research. We reflect on the conception of children’s voice in research and argue for an understanding of voice that goes beyond verbal language. We suggest a combination of perspectives from arts-based research and clinical interview practice to support our understanding of children’s voice in research. As an illustration, we draw on an example taken from a large research project in Youth Mental Health Collaborative Care during which 23 children under the age of 12 were interviewed using a talk-play-draw model. We discuss the multidimensional aspect of children’s voices and the ethical value of arts and play in research interviews. We highlight the importance of researchers’ ethical reflexivity and creative participation in their quest to understand children’s voices. While doing so, we emphasize the responsibility of researchers to interpret, translate and represent as justly as possible a multi-layered, complex and often disorganized voice into a form that is accessible to the linear world of academic research. Given that it is perhaps inevitable that researchers use their own voice in this process, we argue that in conducting research with children, we need to engage both the children as participants and the researchers as advocates for children’s perspectives.

6.7 IMPLEMENTING COMPREHENSIVE MANAGEMENT OF COMORBID PSYCHOPATHOLOGY IN CHILDREN WITH EPILEPSY: A COLLABORATIVE CARE MODEL

This presentation will review essential elements of collaborative mental health care in children with epilepsy (CWE), including screening and treatment strategies. An integrated mental health care program incorporating these elements within the pediatric epilepsy clinic at the University of California, San Francisco (UCSF), will be discussed, with a focus on its implementation, mental health, and quality-of-life outcomes.

Challenges in conducting research on collaborative mental health care: a qualitative study.

We sought to understand poor uptake of the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs), a pragmatic randomized controlled trial of a collaborative care intervention for people experiencing depression, anxiety or at-risk drinking. We explored primary care providers' experience with PARTNERs, and preferences regarding collaborative care models and trials. In this qualitative study, we interviewed primary care providers across Ontario who had participated in PARTNERs, using stratified sampling to reach high-, low- and nonreferring providers in urban and rural settings. We audio-recorded, transcribed and thematically analyzed the interviews between May and December 2017, collecting and analyzing data concurrently until achieving saturation. We interviewed 23 primary care providers. They valued the unique availability of telephone-based coaching for patients but desired greater integration of the coach into their practice. They appreciated expert psychiatric recommendations but rarely changed their practices. Sites varied in organizational adoption and implementation of the study, including whether they designated a local champion, proactively identified eligible patients, integrated the study into existing workflows and reflected on (and revised) practices. These behaviours affected continuing awareness of the study and referral rates. Study uptake was influenced by the limited relationship between PARTNERs coaches and primary care providers, and variable attention to leadership, training and quality improvement as vital elements of collaborative care. Study designs focusing on implementation could promote reach and penetration of novel interventions in the practice setting and more successfully advance collaborative care implementation.

Collaborative mental health care program versus a general practitioner program and usual care for treatment of patients with mental or neurological disorders in Germany: protocol of a multiperspective evaluation study

BackgroundGerman statutory health insurances are pursuing the goal of improving treatment of chronically ill people by promoting networks of health care providers and supporting treatments that reflect the current medical knowledge. The so-called PNP program is a collaborative care program developed by a German statutory health insurance, which defines specific rules on psychiatric, neurological, psychosomatic, and psychotherapeutic treatment. It aims to strengthen provision of guideline-based outpatient treatment and collaboration between different health care providers. It includes the general practitioners’ program, which aims to strengthen the coordinating role of GPs. This study aims to evaluate the PNP program.MethodsTo evaluate the effectiveness of the PNP program, we will conduct a prospective non-randomized controlled trial with primary data comparing patients enrolled in the PNP program and in the general practitioner program (intervention group) to patients enrolled only in the general practitioner program and patients who receive usual care (control groups). To evaluate costs and level of detail of diagnoses in care of patients with PNP program, we will use routinely collected secondary administrative health data in a retrospective quasi-experimental design. Patients who are at least 18 years old, insured by the statutory health insurance AOK, and on sick leave due to one of the mental or neurological diagnoses (affective, anxiety, somatoform or adjustment disorders, alcohol use disorders, schizophrenia, multiple sclerosis) will be included. We will collect data at baseline and at 12-months follow-up. Health-related quality of life (primary data) and direct costs (secondary data) caused by outpatient and inpatient service utilization and medication will be the primary outcomes. We will analyze data using (generalized) linear mixed models and exploratory analyses. We will use entropy balancing to control for possible differences between the groups. We will use an exploratory sequential design including qualitative and descriptive statistical analyses to assess the structure and process quality of the PNP program among health care providers.DiscussionThe results will help to develop a comprehensive picture of collaborative care programs for mental and neurological health care from the perspective of patients, health care providers, and health insurance companies.Trial registrationGerman Clinical Trial Register DRKS00013114

Improving collaborative mental health care across Australia: development and evaluation of the Mental Health Professionals Network (MHPN) initiative

Introduction : The Mental Health Professionals Network (MHPN) was established in 2008 to improve consumer outcomes in the primary care sector by fostering a collaborative clinical approach to the provision of mental health care in Australia. MHPN is a not-for-profit organization funded by the Australian Government Department of Health. This presentation will describe the development of MHPN and present results of evaluations of MHPN’s two key programs. Short description of practice change implemented : The MHPN national platform has two key programs by which it promotes collaborative mental health care: network meetings and webinars. MHPN interdisciplinary networks comprise groups of practitioners who meet face-to-face on a regular and voluntary basis. While networks are self-directed in determining membership and content covered, MHPN provides strategic and planning advice, and manages meeting logistics, communications, and administration tasks. At 30 June 2016 there were 380 networks across Australia with a total of over 10,000 participants. During 2015-16 there were 1,171 network meetings and 14,835 network meeting attendances. MHPN professional development webinars feature case-based discussions by leading experts, modelling interdisciplinary practice and collaborative care. From December 2010 to 30 June 2016, MHPN produced 52 webinars. Overall, there have been more than 160,000 individual views of the live webinars or downloadable podcasts. Aim and theory of change : Collaborative practice is recognised as a necessary element for an integrated health delivery system. MHPN’s activities are based on the premise that if practitioners from different disciplines connect and communicate on a regular basis, clinical pathways will be more effective, referrals better informed and service-delivery improved. Targeted population and stakeholders: MHPN targets psychiatrists, general practitioners, psychologists, mental health nurses, social workers, pediatricians, occupational therapists and other mental health practitioners. Timeline : MHPN was established in 2008 and continues to grow and evolve. Highlights : During 2015-16, evaluations of MHPN’s two key programs were undertaken: Study 1 surveyed network meeting attendees and assessed change across seven areas relating to increased awareness of and interaction with professionals from other disciplines. More than 75% respondents had made each practice change, with those who attended more meetings significantly more likely to have made changes. Study 2 surveyed webinar attendees. Three months post-webinar, 80% respondents had made practice changes, including increased confidence in providing mental health care, increased discussions about other disciplines and improved targeting of referrals. Comments on sustainability : MHPN continues to monitor its structure, policy and practice in order to maintain sustainability of the initiative. Comments on transferability : The MHPN initiative is potentially transferable to other settings and countries. Discussion and Conclusions : The two studies demonstrate that MHPN interdisciplinary network meetings and professional development webinars have impacted positively on health professionals’ attitudes and practices towards a more collaborative approach to mental health care, highlighting the success of the MHPN initiative. Evaluation findings will be published in the Journal of Integrated Care in 2018. Lessons learned : The high attendance at both network meetings and live webinars underscores the strong interest and desire amongst Australia’s mental health workforce for interdisciplinary networking and professional development opportunities.

At the coalface of collaborative mental health care: A qualitative study of governance and power in district-level service provision in South Africa.

Globally, there is an urgency to address fragmented mental health systems, especially in low-to-middle income countries. State and non-state mental health service collaboration is a central strategy to strengthen care. The study was undertaken to analyse the power in governance processes of public mental health service provision. Semi-structured interviews were conducted with state and non-state actors in mental health care in a South African district. Transcriptions were thematically analysed using the Framework for Assessing Power in Collaborative Processes. Findings suggested that collaborative processes were significantly state-owned, in terms of funding models, administrative and legislative jurisdiction, and state hierarchical referral structure. No formal agreements were in place, elevating the importance of key network actors to bring less-endowed NGOs into the service network. Fragmentation between the Departments of Health and Social Development was telling in district forums. Resistance to power structures unfolded, some participants sidestepping traditional hierarchies to leverage funding and support. The paper highlights the complexities and different facets of power in integrated mental health care in a South African district, adding to growing literature on the social mechanisms that influence collaboration.

Adaptation in Delivering Integrated Care: The Tension Between Care and Evidence-Based Practice.

Clinical practice is assumed to be informed and supported by evidence-based clinical research. Nonetheless, clinical practice often deviates from the research evidence base, sometimes leading and sometimes lagging. Two examples from integrated care in mental health care (care for serious mental illness and collaborative mental health care in primary care settings) illustrate the natural space and therefore tension between evidence and implementation that needs to be better understood. Using the tools and perspectives of both examples, the authors present a framework for the connected relationship between practice and research that is founded on measurement and uses iterative adaptation guided by oversight of and feedback from the stakeholders in this process.

Collaborative mental health care in the bureaucratic field of post-apartheid South Africa

ABSTRACTSouth Africa's long and arduous journey from colonial and apartheid-era care for people with mental illness to more comprehensive, equitable mental health care is well-described. Deeper engagement with the structural power dynamics involved in providing collaborative mental health services are less-well described, especially in its post-apartheid era. This conceptual article positions state and non-state mental health service providers – along with their relationships and conflicts – within Bourdieu's bureaucratic field. It is suggested that key internecine struggles in South Africa's post-apartheid socio-political arena have influenced the ways in which collaborative mental health care is provided. Drawing from two recent examples of conflict within the bureaucratic field, the article illustrates the ways in which neoliberal forces play out in contemporary South Africa's mental health service delivery. Struggles between the state and private healthcare in the Life Esidimeni tragedy receive focus, as well as the shifting of responsibility onto civil society. A court case between the state and a coalition of non-profit organisations provides further evidence that neoliberal rationalities significantly influences the position and power of non-state service providers. Unless serious consideration is given to these dynamics, collaborative mental health care in South Africa will remain out of reach.

Change in mental health collaborative care attitudes and practice in Australia

PurposeThe Mental Health Professionals Network (MHPN) was established to support and enhance collaborative care among health professionals working in primary mental healthcare. The MHPN has two primary arms: face-to-face network meetings and online webinars. The purpose of this paper is to investigate attitudinal and practice changes amongst health professionals after participation in MHPN’s network meetings.Design/methodology/approachIn April 2016, an online survey was e-mailed to health professionals who had attended at least one network meeting during 2015. The survey asked about practice changes across seven key areas relating to increased awareness of and interaction with professionals from other disciplines. Interdisciplinary differences were investigated using the χ2 statistic (p<0.05).FindingsA total of 1,375 health professionals participated in the survey. For each of the seven practice changes investigated, between 74 and 92 per cent of respondents had made the change. Those who attended more network meetings were significantly more likely to have made changes. General practitioners were significantly more likely than other professionals to have made changes.Research limitations/implicationsAttendance at MHPN network meetings has a positive impact on health professionals’ attitudes and practices towards a more collaborative approach to mental healthcare.Originality/valueMHPN is a unique, national platform successfully delivering opportunities for interdisciplinary professional development in the primary mental health sector. The model is unique, cost-effective, practitioner driven and transferable to other settings.