Community Mental Health Facilities Research Articles

Availability of Medications for Opioid Use Disorder in Community Mental Health Facilities

Medications for opioid use disorder (MOUD) are an effective but underutilized treatment. Opioid use disorder prevalence is high among people receiving treatment in community outpatient mental health treatment facilities (MHTFs), but MHTFs are understudied as an MOUD access point. To quantify availability of MOUD at community outpatient MHTFs in high-burden states as well as characteristics associated with offering MOUD. This cross-sectional study performed a phone survey between April and July 2023 among a representative sample of community outpatient MHTFs within 20 states most affected by the opioid crisis, including all Certified Community Behavioral Health Centers (CCBHCs). Participants were staff at 450 surveyed community outpatient MHTFs in 20 states in the US. MOUD availability. A multivariable logistic regression was fit to assess associations of facility, county, and state-level characteristics with offering MOUD. Surveys with staff from 450 community outpatient MHTFs (152 CCBHCs and 298 non-CCBHCs) in 20 states were analyzed. Weighted estimates found that 34% (95% CI, 29%-39%) of MHTFs offered MOUD in these states. Facility-level factors associated with increased odds of offering MOUD were: self-reporting being a CCBHC (odds ratio [OR], 2.11 [95% CI, 1.08-4.11]), providing integrated mental and substance use disorder treatment (OR, 5.21 [95% CI, 2.44-11.14), having a specialized treatment program for clients with co-occurring mental and substance use disorders (OR, 2.25 [95% CI, 1.14-4.43), offering housing services (OR, 2.54 [95% CI, 1.43-4.51]), and laboratory testing (OR, 2.15 [95% CI, 1.12-4.12]). Facilities that accepted state-financed health insurance plans other than Medicaid as a form of payment had increased odds of offering MOUD (OR, 1.95 [95% CI, 1.01-3.76]) and facilities that accepted state mental health agency funds had reduced odds (OR, 0.43 [95% CI, 0.19-0.99]). In this study of 450 community outpatient MHTFs in 20 high-burden states, approximately one-third offered MOUD. These results suggest that further study is needed to report MOUD uptake, either through increased prescribing at all clinics or through effective referral models.

Addiction and pregnancy: case report on gender perspective.

IntroductionIn recent years, interest has grown in understanding the particularities of addiction in women. One of these singularities, with an important impact on public health, is pregnancy. Substance use during pregnancy has increased in recent decades. Given that addiction is mainly a chronic disease of the brain circuits of reward, motivation and memory, an event such as pregnancy does not exempt people who suffer from substance use disorder (SUD) from the difficulties of achieving abstinence. Moreover, as addiction often involves cycles of relapse and remission, pregnant women can also suffer a relapse even if they previously had achieved abstinence. On the other hand, given that addiction is a disease with a significant social component, we can find patients in precarious economic and social situations who suffer unwanted and therefore unplanned pregnancies.ObjectivesTo describe the case of a pregnant woman with SUD for multiple drugs who is admitted to the inpatient ward of the Hospital Clínic of Barcelona for detoxification. Also to reflect, taking in to account gender perspective, on the particularities of substance use in women on childbearing age.MethodsWe present the case of a 25-year-old woman, six weeks pregnant and homeless, who was admitted to the inpatient ward for presumed psychotic symptoms. Even if the patient had a history of intravenous heroin, cocaine, and methamphetamine use, during the admission she only admitted current alcohol consumption (3 UBE/day). During admission, the patient decided to undergo a legal voluntary abortion. Regarding this case, we did a literature review on the consequences of different substances use to pregnancy (to both the fetus and the mother’s health). Likewise, we reflected on interventions that could be carried out in community mental health facilities to detect cases like the one exposed and provide help.Results Poor obstetric outcomes are six times higher in patients who use substances. Newborns can have withdrawal syndrome, spontaneous abortion, pre-term birth, fetal malformations and fetal growth restriction. More than 50% of women of reproductive age use drugs, mainly alcohol. Routine screening and education of women of reproductive age is the best way to reduce substance use during pregnancy.ConclusionsWe consider it essential for a better management of these patients to remember that the evidence suggests that the decisions that addicts make are mainly driven by a pathology, not by a moral failure. However, pregnancy can be a moment of greater motivation to stop using drugs, given that it is a high risk situation for the mother and the fetus.Disclosure of InterestNone Declared

NIMBYism and Strategies for Coping with Managing Protests during the Establishment of Community Mental Health Facilities in Taiwan: Insights from Frontline Healthcare Professionals.

Taiwanese community mental health facilities encounter opposition/resistance from residents, commonly known as "Not-In-My-Backyard" (NIMBYism). This study investigated NIMBYism during the establishment of such facilities and how they respond to such resistance. A qualitative study through semi-structured interviews was used to obtain purposively sampled data. Fifteen frontline healthcare professionals from community mental health facilities in Taiwan were interviewed individually, using an organizational analysis structure. Data were analyzed using qualitative content analysis. Two themes: "Reasons for Resident Resistance" and "Institutional Response Strategies", two categories, and 11 subcategories emerged. The findings demonstrated the following: (1) Reasons behind residents' resistance toward establishing community mental health facilities are diverse. (2) Communities lack understanding regarding people with mental disorders, leading to irrational beliefs. (3) Fear and negative perceptions toward people with mental disorders exist. (4) Strategies employed by the facilities include providing community services to foster amicable relationships, organizing community outreaches, training people with mental disorders within communities, nurturing neighborhood connections, establishing and sustaining friendships within communities, inviting residents to visit community mental health facilities or introducing the facilities to communities, and leveraging governmental support. The government should adopt regulations or laws to reduce discrimination, promote human rights, and legislate to demarcate the use of community land.

Virtual care delivery of whole family assessment and intervention with infants and preschoolers: a thematic analysis of clinician and family experiences

AbstractIn this study, we explore family and clinician experiences with virtual care delivery of whole family assessment and therapy developed for infant and preschool‐aged children and adapted during the COVID‐19 pandemic. A clinical case study is also presented. Between September and November 2020, semi‐structured interviews were conducted with four clinicians working with families with children in the 0 to 5 population and with four caregivers with children aged 4–6 years (M = 5.3) involved in whole family assessment and intervention (i.e., Lausanne Trilogue Play [LTP]; Reflective Family Play [RFP]) at a community mental health facility. Clinicians represented various mental health disciplines. Qualitative data were analysed using inductive thematic analysis with intercoder reliability established. Analysis of interviews generated nine themes organised within two conceptual frameworks, accessibility and efficacy. Accessibility included the themes: (1) flexibility, (2) privacy, and (3) resources. Efficacy comprised: (4) effects of technology, (5) home environment, (6) feasibility of therapy tasks, (7) parent alliance, (8) clinician fatigue, and (9) overall evaluation. Home environment was further divided into three subthemes: (5.1) disruptions, (5.2) boundaries, and (5.3) naturalistic observation. While participants reported benefits and challenges uniquely related to virtual care, both caregivers and clinicians expressed overall satisfaction with virtual whole family assessment and therapy. This study provides a rich exploration of the perspectives of caregivers and clinicians engaged in virtual whole family mental health care during the COVID‐19 pandemic. With adequate technology and privacy, whole family assessment and therapy, such as the LTP and RFP, provided via video teleconferencing facilitated accessible and effective care for families of young children with moderate to severe mental health challenges. Evidence suggests in‐person and hybrid approaches to whole family assessment and therapy could be further tailored to meet the needs of families with young children and infants.

A formative assessment of client characteristics associated with missed appointments in integrated primary care services in rural Arizona.

Integrating primary care services in mental healthcare facilities is an uncommon model of care in the United States that could bring several benefits (e.g., improved access to physical healthcare) for vulnerable populations experiencing mental health conditions, especially those living in underserved regions like rural Arizona. This formative assessment aimed to understand the sociodemographic and clinical characteristics of clients accessing integrated primary care (IPC)services implemented in 2021 at a community mental healthcare facility in rural Arizona and to explore the proportion of missed appointments. Additionally, we analysed the association between client characteristics and IPC missed appointments. The authors collaborated with a community mental health facility in rural Arizona, which provided deidentified data from 280 clients who accessed IPC services from June 2021 to February 2022. Most clients were White and of vulnerable socioeconomic status, with a substantial proportion of Native Americans (23.58%). The majority of clients (55.75%) had a mental health disorder (MHD),23.74% had a substance use disorder (SUD),and 15.10% had comorbid MHD and SUD. Linear regression revealed that experiencing comorbid MHD and SUD was significantly associated with missed appointments. Compared with White clients, Native Americans missed fewer appointments. Future studies conducted from a culturally-centred perspective are crucial to guide strategies to reduce missed appointments in rural IPC services.

Dialectical Behavior Therapy Skills and Urges to Use Alcohol and Substances: An Examination of Diary Cards

Background: Skills learned in Dialectical Behavior Therapy (DBT) are a proposed mechanism that prompts behavior change. Few studies have examined the effects of DBT skills on treatment outcomes. No published studies have examined the effects of DBT skills on alcohol and substance use outcomes. Objectives: This study examined 48 individuals in a community mental health facility that delivers DBT-adherent treatment. Utilizing intake data and diary cards, multilevel model analyses were conducted to examine the effects each DBT skills domain had on urges for participants that entered treatment with varying frequencies of alcohol and substance use. Results: Emotion regulation and mindfulness skills domains were related to decreased urges for individuals that entered treatment with high frequencies of alcohol and substance use. Previous-day distress tolerance skills were associated with decreased urges and previous-day interpersonal effectiveness skills were associated with decreased urges for individuals that entered treatment with high frequencies of substance use. Conclusions: DBT skills may be a helpful mechanism to decrease urges for individuals that use alcohol and other substances. However, more research on why certain skills domains may be more effective is needed.

Characterizing supervision-as-usual: Findings from two provider surveys.

Although clinical supervision is widely seen as critical for professional training and for safeguarding and promoting client well-being in mental health care, it is understudied, particularly in publicly funded services. In surveys of two large samples of youth mental health service providers (a state sample of providers billing Medicaid [N = 1,057] and a national sample of professional guild members [N = 1,720]), we examined the amount of time providers reported spending in supervision and consultation in a typical workweek and its covariation with characteristics of providers' caseloads and work settings. Across both samples, providers reported spending an average of 2-3 hr per week in supervision. Serving higher percentages of low-income clients was associated with significantly more supervision time. Working in private practice was associated with less supervision, while community mental health and residential facilities were each associated with more supervision time. The national survey also measured providers' perceptions of their current supervision. On average, providers endorsed feeling comfortable with the amount of supervision received and supported by their supervisors. However, working with more low-income clients was associated with greater need for supervisor approval and oversight and with less comfort in the amount of supervision received. Those working with more low-income clientele may benefit from additional supervision time or more focused supervision coverage of the specific needs of clients with low-income. More in-depth research on critical processes and content in supervision is a much-needed future direction for supervision research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Therapists' practical implementation and preparation of online counseling in the post-pandemic era.

In recent years, COVID-19 has led to a blossoming of online counseling (OC) as an important and alternative way to help people in need. In this regard, the present study aims to explore and clarify therapists' practical implementation and preparation of OC in the post-pandemic era by developing scales. In total, 306 Taiwanese licensed therapists participated in this study and filled out the developed scales (75 males and 231 females, 246 of whom have provided OC to clients). The psychometric analysis revealed that the two scales developed in this study, the implementation of OC scale and the preparation of OC scale, have positive reliability and validity. The former consists of three factors: standardized process, presence of infrastructure, and similarity in practice, and the latter comprises two factors: intent to conduct OC and perceived benefits for clients. In addition, the results indicated that therapists who are elder, more experienced, or working in community mental health facilities showed better practical implementation and preparation of OC. Findings from this study carry useful reference for strengthening therapists' preparation for and the effectiveness of OC.

Establishing community mental health facilities: a comparative review of Hong Kong and international jurisdictions

BackgroundThe establishment of mental health facilities in the community has been hindered by opposition from local residents in Hong Kong. Through a comparative review, this study aimed to compare the issues related to the process of establishment of community-based mental health facilities between Hong Kong and selected overseas countries and regions. It will better inform the strategies and best practices that can be adopted for the establishment of mental health facilities in Hong Kong.MethodsThree electronic databases (PubMed, Scopus, and PsycINFO) were used to examine literature on nine jurisdictions in Asia and western societies from 2005 to 2019. In addition, we conducted a number of in-depth interviews with overseas experts to gain in-depth insights and clarify information that was unavailable or unclear. A total of 19,248 articles were identified through the initial search. 71 of them met the inclusion criteria. In addition, 20 articles about the establishment of other types of community facilities or sensitive facilities were identified from supplementary sources.ResultsMost Western countries and Singapore have adopted regulations or laws to reduce public discrimination against particular groups, giving them corresponding human rights and legislating to demarcate the use of land in the community. Regions close to Hong Kong emphasize communication with community leaders to obtain support for sensitive services or facilities.ConclusionsHong Kong may consider strengthening the land zoning ordinance in relation to community sensitive facilities, as well as increasing communication with the community and considering the possibility of locating facilities in government buildings.

What Explains Changes in Availability of Specialty Mental Health Services in Organized Settings?

Community mental health facilities often do not offer the full range of evidence-based clinical and support services for individuals with serious mental illness. This creates equity issues, particularly when low-income and minority communities have access to fewer facilities. Medicaid expansion might encourage facilities to offer these services. However, this decision may also be affected by facility ownership type or mediated by service cost structure, particularly in the absence of innovative payment mechanisms. In this study, we determine whether and how Medicaid expansion and facility ownership are associated with changes in specialty mental health service availability in organized settings over time. We estimated two-way fixed effects models using six cross-sections of the National Mental Health Services Survey and compared changes in facility-reported offering of seven services from 2010 to 2019 (54,885 facility years): psychotropic medication, case management, family psychoeducation, psychiatric emergency walk-in services, supported employment, assertive community treatment, illness management, and recovery services. We tested whether Medicaid expansion and facility ownership (private for-profit, private not-for-profit, public) were associated with differential changes in service availability from 2010 to 2019. Overall, facilities were no more likely to offer nearly all services in 2019 than 2010. We found smaller declines for psychotropic medication and psychiatric emergency walk-in services among facilities in Medicaid expansion states compared to declines in non-Medicaid expansion states (6.3 (95% CI 95% CI = 1.8-10.7) and 5.5 (95% CI = 0.2-10.8) percentage points respectively). For-profit facilities experienced the largest declines in availability from 2010 to 2019, while public facilities experienced the smallest declines and some increases in availability of select services. Specialty mental health services are still not widely offered in community outpatient settings despite significant investments in Medicaid, although Medicaid expansion was associated with slower declines in availability. New payment models that incentivize outpatient facilities to offer clinical and support services may be needed.

Electroconvulsive Therapy Without General Anesthesia and the Human Rights of Mental Health Patients

The use of unmodified electroconvulsive therapy (ECT), i.e., ECT without general anesthesia, vis-a-vis human rights of mental health patients and standards of care, is discussed. An overview of unmodified ECT is provided, followed by an account of recent events in Chile, where the Minister of Health referred the administration of unmodified ECT to the judicial system. The article concludes with a proposal to launch a voluntary system of accreditation, by which countries willing to have their mental health services accredited by the World Health Organization (WHO) would commit themselves to give unrestricted, unannounced, and at short-notice access to independently appointed the WHO representatives to their community and inpatient mental health facilities.

An Observational Study on the Walking Proximity between Off licenses plus Bookmakers and Community Mental Health Facilities in County Dublin

IntroductionDual diagnosis is commonly treated by Community Mental Health Team (CMHT). Addiction is a common complicating factor in individuals with major mental illnesses. It is established that businesses on high streets impact on the public’s health.ObjectivesWe hope to generate discussion about the planning and the placement of community mental health services.MethodsThe location of County Dublin community mental health teams’ outpatient clinics’ and day hospitals’ were obtained from the Health Service Executive directory website. All off licenses’ and bookmakers’ addresses in County Dublin were obtained from the Irish Revenue Commissioners website. The distances were measured using Google Maps and a programming script to generate a matrix under one-kilometre radius walking distances between the locations. No ethical approval is required. All Data are sought from publicly available websites.ResultsOn average, there are 6.29 (SD 4.20; Median 5.) off-licenses and 2.4 (SD 2.28; Median 2) bookmarkers offices per mental health facility within1 km walking distance. The Central Dublin Mental Health Service has the highest prevalence of off-licenses (45, 34.4%), and the Central South Dublin Service(20, 39.2%) has the highest prevalence of bookmakers. Southeast Dublin Service has the lowest in both businesses. The closest distance to an off-license from mental health facilities was 0 meters.ConclusionsPsychiatrists have a role in advocating the needs of individuals with dual diagnoses. The Department of Health and Health Service Executive (HSE) should develop a guideline and protocol for the community health services in the structuring and planning mental health services in the community health outpatient service setup.DisclosureNo significant relationships.

Observation of Rare Psychosocial and Mental Health Symptoms in ISIS Psychiatric Patients: A Pilot Study Among ISIS Affiliates

Objectives: The invasion of Iraq and Syria by the so-called "Islamic State of Iraq and Syria" (ISIS) began in 2014. Most of the people were displaced or forced to migrate in great numbers, and as a result, they suffered from mental and emotional disorders. The purpose of this pilot study is to assess ISIS psychiatric patients and report on possible unusual psychosocial symptoms that may occur among them. Methods: The prospective multicenter study, which included 18 patients from a community mental health facility within the IDP camp in Ninewa, included nine former ISIS members and nine general controls both groups suffering MDD and PTSD. The purpose of this study was to screen for unusual signs and symptoms using a semi-structured interview and a mental health assessment. Results: There were a total of nine patients from ISIS affiliates, with an average age of 29 years. The ISIS patients met DSM-V diagnostic criteria for MDD, PTSD, and unusual psychosocial symptoms, but the control group only met DSM-V diagnostic criteria for general mental illnesses, not unusual psychosocial symptoms. This is the first time that uncommon psychosocial symptoms including low self-esteem, dread, suicidal thoughts, aggressive behavior, self-blaming, isolation, and disguising identity have been identified among ISIS psychiatric patients. Conclusion: Extremist groups, particularly ISIS affiliates, are thought to have a considerable prevalence rate of uncommon symptoms, which are thought to be unique to them. Future studies should be encouraged in order to understand more about these unique and unusual characteristics in order to find a more effective therapy and it may be recognized as a novel syndrome.

Evaluation of a Mother-Infant Dyadic Video-Feedback Intervention in a Community Health Center in South Bronx, New York City.

This study evaluates a video-feedback program's effectiveness in promoting responsive and sensitive parenting for families in care in a community health center located in the South Bronx, New York City. Change in measures of parent responsiveness/sensitivity (Global Rating Scale), depression (Patient Health Questionnaire 9), anxiety (Generalized Anxiety Disorder 7), and parenting stress (Parenting Stress Index-Short Form) were analyzed for mother-infant dyads (N=34) completing a six-session videofeedback program between 2014 and 2016. Participants were primarily mothers of color (30% African American; 63% Hispanic) with young infants (mean age 8 months). At program completion, mothers demonstrated a significant improvement of 19% in maternal responsiveness and fewer depressive and anxious symptoms. Cost-effectiveness studies are needed to compare parenting interventions by setting (community health center, home, or mental health facility) for acceptability and effectiveness to determine best practice models for communities challenged by poverty, trauma, and health disparities.

Workplace spirituality and organizational justice in turnover intention of mental health professionals at small-sized centres.

To investigate the influence of workplace spirituality and organizational justice on the turnover intentions of mental health professionals working in small-sized communities. Many community mental health facilities in Korea are consist of the small size of members, and the turnover rate of mental health professionals is high. However, the influence of individual and organizational factors for lowering the turnover is not clearly identified. This was a descriptive study. Data of 168 participants were collected through a self-reported online questionnaire using a convenience sample, June 2020. Multiple regression analysis uses interactional justice (β= -.437, p= .002), distributional justice (β= -.190, p= .011) and age (β= -.152, p= .033) that were the most important predictors of turnover intention. Orgnisational factors such as distributional and interactional justice affect to reduce turnover intention more than an individual factor like the workplace spirituality of professionals. Small-sized mental health institutions in the community should establish a clear working guideline that can make the distribution, procedure and interactional justice. Because only a small percentage of nurses work at community mental health facilities, it is necessary to reduce turnover by creating a work environment where young nurse practitioners can work long-term and grow into leaders.

Victimization of People With Severe Mental Illness Outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors From a Multicenter Study.

We performed a cross-sectional study using a self-reporting survey to assess lifetime violent and non-violent victimization in people with severe mental illness experienced both inside (i.e., any service providing mental health care such as psychiatric hospitals, psychosocial rehabilitative programs, or outpatient care) and outside (i.e., in the personal life of the participants) of the mental health care system. We recruited 170 participants from 20 community mental health facilities. We built logistic regression models to assess potential risk factors for victimization inside the mental health care system. Outside of the mental health care system, the most commonly reported events were theft (n=93, 54.7%), physical violence without use of a weapon (n=87, 51.2%), and sexual harassment (n=82, 50.6%). Within the mental health care system, most commonly reported incidents were theft (n=68, 40.0%), sexual assault (n=18, 10.6%), and physical violence (n=47, 27.7%) by other patients or staff. Significant risk factors for specific victimization events inside the mental health care system were psychotic disorder, victimization in childhood and youth, female gender, number of hospitalizations, and duration of illness. Findings call for increased attention to victimization of people with severe mental illness, especially within the mental health care system as such victimization events may severely impact patients’ trajectories.

Implementing research and best practice for the development of community mental health facilities

Abstract Healthcare is a sociotechnical system in which the technical system is interrelated to a social system of people and organization, including users, staff, carers, equipment, medication. Emphasis remaining on the latter, contributes to stigma. Outpatient services provide for the public health key components of early detection and support. This project was initiated by an NHS Mental Health Trust at a stage of building redevelopment. It aimed at gathering state of the art, best practice, innovative and challenging approaches on psychiatric buildings to inform an extensive multi-stakeholder and patient inclusive co-design process, useful for both the UK and other settings. Research followed a qualitative methodology gathering data on best practice in community mental health facilities globally. First, a literature review was conducted with focus on built environment. Additionally, best practice case studies were analysed. In parallel, interviews with international experts were conducted. How can we incorporate out of the box design thinking, as a means to challenge the culture of psychiatric provision? How can we enable integration with non-psychiatric health systems and potentially inverse-integration practices? Data were evaluated using the SCP model, a tool developed for the evaluation of psychiatric buildings. Results were organised under 32 key themes. These were further digested in two sections - the first comprising a set of design learnings and the second presenting visual material. Findings from the key themes were then organised in a matrix of design recommendations for wards and community mental health hubs to support patient, staff and community consultations with food for thought. By treating design and place-making as a therapeutic tool we could challenge the way people view mental health buildings. Creating the means -review and inclusive consultation structure - to disrupt a normally segregated architectural dialogue - was essential to this process. Key messages Feedback methods for patient staff-consultation for capital planning: supporting staff and patients into the dialogue, increasing design and planning literacy. Evidence base, best practice and experimental design together for extracting meaningful feedback during capital planning consultation processes: we could learn from all three.

Still worlds apart: flourishing in people with mental health problems

PurposeThe purpose of this paper is to compare a group of service users with mental health problems with a community comparison group of gym attenders.Design/methodology/approachCross-sectional questionnaire surveys were conducted at a large gym (n = 181) and two community mental health facilities (n = 127) in the Greater Manchester area using a convenience sample approach. All participants completed the PERMA Scale, a measure of flourishing.FindingsGym attenders scored significantly higher on the five elements of PERMA. Their physical health ratings were almost double. They also had significantly lower levels of negative emotions and loneliness and higher levels of overall happiness.Research limitations/implicationsThis study only considered levels of flourishing. Previous studies of quality of life have shown similar disparities between people with mental health problems and others.Practical implicationsProfessor Seligman has claimed that improving levels of flourishing is the main aim of positive psychology. The present study suggests this may be especially challenging for people with mental health problems.Social implicationsThe concept of flourishing could provide a more positive non-medical focus for mental health services, in the development of what some have called positive psychiatry. This complements the current recovery model.Originality/valueTo the best of the authors’ knowledge, this is one of the first studies to compare flourishing levels between individuals with mental health problems and a community comparison group using the PERMA Scale.

Effectiveness of trauma-focused cognitive behavioral therapy for Japanese children and adolescents in community settings: a multisite randomized controlled trial

ABSTRACT Background Trauma-focused cognitive behavioural therapy (TF-CBT) is an efficacious treatment model for children and adolescents with trauma-related disorders. However, few studies have been conducted in community settings, and there have been no randomized controlled trials in Asian countries. Objective To evaluate the effectiveness of TF-CBT in regular community settings in Japan through comparison with a waitlist with minimal services control condition. Method Thirty Japanese children and adolescents with posttraumatic stress disorder symptoms (22 females, eight males, mean age = 13.90, range = 6–18) were randomly assigned to 12 sessions of TF-CBT or the waitlist control condition. The primary outcome measure was the Kiddie Schedule for Affective Disorders and Schizophrenia score assessed by blinded evaluators one month later. Results The mean number of sessions was 12 (range: 11–13) in the TF-CBT group and 4.87 (range: 3–7) in the control group. Intention to treat analysis showed that the TF-CBT group achieved significantly greater symptom reduction than did the control group. The effect size (Cohen’s d) between the TF-CBT and control groups was 0.96 (p =.014) for posttraumatic symptoms and 1.15 (p =.004) for depressive symptoms. However, the TF-CBT group did not show better results than the control group with regard to improvements in anxiety symptoms, psychosocial functioning, and behavioural problems. Conclusions The findings provided preliminary evidence of the effectiveness of TF-CBT for treating youth with trauma in community mental health facilities. TF-CBT in the Japanese context proved identical to the original, demonstrating that it is also suitable for use with children and adolescents in non-Western settings.

Ensuring mental health care during the SARS-CoV-2 epidemic in France: A narrative review

ObjectiveThe lack of resources and coordination to face the coronavirus epidemic raises concerns for the health of patients with mental disorders in a country where we still have memories of the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims to propose guidance to ensure mental health care during the SARS-CoV epidemic in France. MethodsThe authors performed a narrative review identifying relevant results in the scientific and medical literature and in local initiatives in France. ResultsWe identified four types of major vulnerabilities among patients with mental disorders during this pandemic: (1) medical comorbidities that are more frequently found among patients with mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which are risk factors for severe covid-19 infection; (2) age (the elderly form the population most vulnerable to the coronavirus); (3) cognitive and behavioural disorders, which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability as a result of stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly suited to psychiatric establishments in a context of major shortages of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds have been closed, wards have high densities of patients, mental health community facilities are closed, and medical teams are understaffed and poorly trained to face infectious diseases. There are also major issues when referring patients with acute mental disorders to intensive care units. To maintain the continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of “COVID+ units”. These units are under the dual supervision of a psychiatrist and an internist/infectious disease specialist; all new entrants are placed in quarantine for 14 days; the nursing staff receives specific training, daily medical check-ups and close psychological support. Family visits are prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management are organized with the possibility of home visits, in order to support patients when they get back home and to help them cope with the experience of confinement, which is liable to induce recurrences of mental disorders. The total or partial closure of community mental health facilities is particularly disturbing for patients, but a regular follow-up is possible with telemedicine and should include the monitoring of suicide risk and psycho-education strategies; developing support platforms could also be very helpful in this context. Private practice psychiatrists also have a crucial role of information towards their patients on confinement and barrier measures, and also on measures to prevent the psychological risks inherent in confinement: maintenance of regular sleep r, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DiscussionFrench mental healthcare is now facing a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the confinement of the general population.