Continuity Of Mental Health Care Research Articles

Support Groups Versus Primary Mental Healthcare on Disability and Continuity of Care: Community Trial [Support Groups for Recovery

Based on the need to implement strategies to reduce recovery gaps in mental health with the community as axes of recovery, the objective of the present study was to assess the impact on psychosocial disability and care continuity in individuals with suicidal behavior, of the clinical and community components of the Mental Health Gap Action Program (mhGAP), versus exclusive psychiatric care. For this, a controlled community trial carried out in 2023 was conducted, comprising intervention groups: Support Group (SG), mhGAP Group (mhGAPG) and a Control Group (CG). Self-report measurements were collected pretest and posttest, utilizing the Psychosocial Disability Scale and the Alberta Continuity of Care Scale. The study involved the participation of 94 individuals with a history of suicidal behavior, with 30 individuals in the SG, 34 in the mhGAP group, and 30 in the CG. Categorical variables were summarized using frequency distribution tables. Descriptive statistics were used to examine participants' characteristics at the study outcome and estimate treatment compliance. The Mann-Whitney U Test examined differences in sociodemographic variable frequencies. The Jarque-Bera test confirmed a normal distribution for psychological variables, warranting the use of parametric tests. Differences in mean values across groups, each with two measurements per individual, were assessed using a type II repeated measures ANOVA. There were significant differences based on the intervention, with the effect being greater in the SG across all domains. Significant improvement was observed in all domains of the disability and continuity of care scale within the intervention groups. Both groups showed improvement, with better results for the SG. In conclusion, a methodology is proposed for implementing support groups based on core components, which effectively enhances psychosocial disability and the continuity of mental health care, especially in suicidal behavior.

62 Cognitive Behavioral Therapy Improves Symptoms of Depression in Burn Survivors

Abstract Introduction Burn injury patients can suffer severe trauma as they cope with the events that led to their injuries and their new physical abilities and appearance. Mental health is a component of care that is often overlooked for these patients. The purpose of this prospective study was to evaluate whether burn psychotherapy is effective in reducing depression in burn survivors. Methods Our Burn Center has a full time licensed clinical psychotherapist who uses Cognitive Behavioral Therapy (CBT) to treat patients. Burn clinic nurses administered the Patient Health Questionnaire-9 (PHQ-9) depression screener to n=1842 patients between 2016-2019. Patients were referred to psychotherapy if their total PHQ-9 score met the definition for moderate depression (total score ≥ 10) or they endorsed the question about suicidal thoughts. Patients could also participate through self-referral. Our final sample included n=146 patients (47% female, mean age=41.8) who attended at least one psychotherapy appointment and contributed at least one post-appointment PHQ-9 score. We computed a difference score for each patient by subtracting their baseline PHQ-9 score from their mean post-psychotherapy score. We used a one sample t-test to compare the mean difference score for the group to zero (zero = no change). We also examined how many participants showed a change in PHQ-9 category from pre- to post-psychotherapy. Results The mean baseline score was 11.49 (SD = 6.92) vs. mean post-psychotherapy score 8.54 (SD = 6.45). The mean group difference score was significantly different from zero (mean = -2.95, SD=5.72), t(145)=-6.23, p< 0.001, [95% CI = -3.88 to -2.01]. The negative mean difference indicates a decrease in depressive symptoms. When examining changes in depression category, 50.7% of patients moved to a less severe category of depression after psychotherapy, 13.7% of patients moved to a more severe category, and 35.6% did not change. Conclusions These results support psychotherapy as a measurable benefit to some, but not all individuals undergoing specialized burn care. Burn centers should consider having a full-time burn- and trauma-trained psychotherapist on staff to complete assessments on admission. Continuity of mental health care in burn centers has the potential to positively influence patient outcomes. Applicability of Research to Practice Cognitive behavioral therapy is used in many different populations. Our findings support the practice of specialized psychotherapy intervention in the burn population as effective in decreasing symptoms of depression in some patients.

Racial And Ethnic Inequities In Postpartum Depressive Symptoms, Diagnosis, And Care In 7 US Jurisdictions.

Understanding whether racial and ethnic inequities exist along the postpartum mental health care continuum is vital because inequitable identification of depression can lead to inequitable referral to and receipt of care. We aimed to expand on existing cross-sectional and single-state data documenting potential racial and ethnic disparities in postpartum depression care. Using early (from two to six months) and late (from twelve to fourteen months) postpartum survey data from seven US jurisdictions, we documented patterns of early postpartum depressive symptoms, perinatal mood and anxiety disorder (PMAD) diagnosis, and receipt of postpartum mental health care overall and by racial and ethnic identity. Of 4,542 people who delivered live births in 2020, 11.8percent reported early postpartum depressive symptoms. Among the sample with these symptoms, only 25.4percent reported receiving a PMAD diagnosis, and 52.8percent reported receiving some form of postpartum mental health care. There were no significant differences in diagnosis by race and ethnicity. Respondents identifying as Asian; Native Hawaiian or Pacific Islander; Southwest Asian, Middle Eastern, or North African; Hispanic; and non-Hispanic Black were significantly less likely than non-Hispanic White respondents to receive mental health care, demonstrating stark inequities in the management of postpartum depressive symptoms. Policies mandating and reimbursing universal postpartum depression screening, facilitating connection to care, reducing insurance coverage gaps, and enhancing clinician training in culturally responsive care may promote equitable postpartum mental health care.

A mixed methods analysis of youth mental health intervention feasibility and acceptability in a North American city: Perspectives from Seattle, Washington.

In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This study aims to ascertain the kinds of support across the mental health care continuum recommended by young people and key stakeholders who could assist with implementation in Seattle. We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among youth. We complimented these data with a 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted a deductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ2 tests to summarize and compare participant characteristics stratified by age group. Qualitative informants attributed challenges to youth mental health to social isolation and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, and substance abuse prevention. Key informants and survey participants identified schools as the most important setting for mental health interventions. There were no significant differences among quantitative outcomes. Our findings highlight the need for interventions that reduce isolation and increase social connectedness to support youth mental health. As the city designs youth responsive interventions, schools and digital platforms should be prioritized. Engaging multiple stakeholders, particularly young people, tackling cultural stigma surrounding mental health, and improving access to safe community spaces are important considerations for youth mental health interventions.

Trends in the availability of community-based psychological counselling services for oldest-old in China, 2005 to 2018

BackgroundCommunity-based psychological counselling services (CPCS) is crucial for the oldest-old who often faces challenges or are reluctant to seek care at the healthcare settings. This study aims to examine trends in availability of CPCS over time and rural-urban disparities in service availability among nationwide oldest-old in China. MethodsMultiple cross-sectional data were derived from the 2005–2018 Chinese Longitudinal Health Longevity Survey. Service availability was reported by each oldest-old participant or their next-of-kins as having CPCS in one's neighborhood. We used Cochran-Armitage tests to estimate service availability trends and applied sample-weighted logistic regression models to examine its rural-urban disparities. ResultsOf 38,032 oldest-old, CPCS availability decreased from 6.7 % in 2005 to 4.8 % in 2008/2009, followed by continual increases to 13.6 % in 2017/2018. In 2017/2018, rural oldest-old's neighborhoods had no greater service availability. Oldest-old residing in the Central (6.7 %), Western (13.4 %) and Northeast China (8.1 %) were less likely to report having services locally than their Eastern counterparts (17.8 %). Oldest-old having any disability or living in the nursing homes reported having greater service availability than those without disability or living at home. LimitationService availability might have been disrupted during the COVID-19 pandemic. ConclusionsDespite the increasing service availability, as of 2017/2018, only 13.6 % oldest-old in China had reported CPCS availability. It raises concerns on the disproportionate access to and continuity of mental health care, especially for those living the Central, Western China and those living at home. Policy efforts are needed to incentivize service expansion and eliminate disparities in the service availability.

A Markov Chain Model for Mental Health Interventions.

Poor mental health affects nearly one billion people worldwide and can end in suicide if not treated. Unfortunately, stigma and a lack of mental healthcare providers are barriers to receiving needed care. We developed a Markov chain model to determine whether decreasing stigma or increasing available resources improves mental health outcomes. We mapped potential steps in the mental health care continuum with two discrete outcomes: getting better or committing suicide. Using a Markov chain model, we calculated probabilities of each outcome based on projected increases in seeking help or availability of professional resources. Modeling for a 12% increase in awareness of mental health concerns yielded a 0.39% reduction in suicide. A 12% increase in access to professional help yielded a 0.47% reduction in suicide rate. Our results show that expanding access to professional services has a higher impact on reducing suicide rates than creating awareness. Any intervention towards awareness or access positively impacts reducing suicide rates. However, increased access results in a higher reduction in suicide rates. We have made progress in increasing awareness. Awareness campaigns help to increase recognition of mental health needs. However, focusing efforts on increasing access to care may have a higher impact on reducing suicide rates.

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

Iowa Funds Expansion of Rural Psychiatry Training, Services for Underserved Populations

After 988’s Launch, Experts Emphasize More Work Needed

After 988’s Launch, Experts Emphasize More Work Needed

Evaluating the pediatric mental health care continuum at an American health system.

To describe trends in the pediatric mental health care continuum and identify potential gaps in care coordination. We used electronic medical record data from October 2016 to September 2019 to characterize the prevalence of mental health issues in the pediatric population at a large American health system. This was a single institution case study. From the electronic medical record data, primary mental health discharge and readmission diagnoses were identified using International Classification of Diseases (ICD-9-CM, ICD-10-CM) codes. The electronic medical record was queried for mental health-specific diagnoses as defined by International Classification of Diseases classification, analysis of which was facilitated by the fact that only 176 mental health codes were billed for. Additionally, prevalence of care navigation encounters was assessed through electronic medical record query, as care navigation encounters are specifically coded. These encounter data was then segmented by care delivery setting. Major depressive disorder and other mood disorders comprised 49.6% and 89.4% of diagnoses in the emergency department and inpatient settings respectively compared to 9.0% of ambulatory care diagnoses and were among top reasons for readmission. Additionally, only 1% of all ambulatory care encounters had a care navigation component, whereas 86% of care navigation encounters were for mental health-associated reasons. Major depressive disorder and other mood disorders were more common diagnoses in the emergency department and inpatient settings, which could signal gaps in care coordination. Bridging potential gaps in care coordination could reduce emergency department and inpatient utilization through increasing ambulatory care navigation resources, improving training, and restructuring financial incentives to facilitate ambulatory care diagnosis and management of major depressive disorder and mood disorders. Furthermore, health systems can use our descriptive analytic approach to serve as a reasonable measure of the current state of pediatric mental health care in their own patient population.

Continuity of mental health care during the transition from prison to the community following brief periods of imprisonment.

PurposeThe prison-to-community transition period is one of high risk and need, particularly for those with mental illness. Some individuals cycle in and out of prison for short periods with little opportunity for mental health stabilization or service planning either in prison or the community. This study describes the socio-demographic, clinical and criminal justice characteristics of individuals with mental illness and frequent, brief periods of imprisonment, examines continuity of mental health care between prison and the community for this group, and reports on their post-release mental health and criminal justice outcomes.Design/methodology/approachThis study examined a sample of 275 men who had recently entered prison in New South Wales (NSW), Australia, who had been charged with relatively minor offenses and had been identified on reception screening as having significant mental health needs. Baseline demographic and mental health information was collected via interview and file review and contacts with the prison mental health service were recorded for the period of incarceration. Follow-up interviews were conducted 3 months post-release to determine level of health service contact and mental health symptoms. Information on criminal justice contact during the 3 month period was also collected.FindingsThe majority (85.5%) of the sample had contact with a mental health professional during their period of incarceration. Mental health discharge planning was, however, lacking, with only one in 20 receiving a referral to a community mental health team (CMHT) and one in eight being referred for any kind of mental health follow-up on release. Of those followed up 3 months post-release (n = 113), 14.2% had had contact with a CMHT. Of those released for at least 3 months (n = 255), one in three had received new charges in this period and one in five had been reincarcerated.ConclusionContinuity of mental health care for those exiting prison is poor, particularly for those with mental health needs experiencing brief periods of imprisonment, and rates of CMHT contact are low in the immediate post-release period. These findings suggest a need for early identification of individuals in this group for timely commencement of intervention and release planning, and opportunities for diversion from prison should be utilized where possible.

University of Michigan First to Test APA Model for Assessing Psychiatric Bed Needs

University of Michigan First to Test APA Model for Assessing Psychiatric Bed Needs

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study.

Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood. Seventy adolescents in shared residential care, placed by child welfare (n=52, mean age=15years) or juvenile justice (n=18, mean age=17years) authorities, were followed up into adulthood (child welfare: mean age=25years; juvenile justice: mean age=27years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed. In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples. Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.

New Milwaukee MH emergency center names its administrator

The new Mental Health Emergency Center, a joint venture between Milwaukee County and the area's four health systems (Advocate Aurora Health, Ascension Wisconsin, Children's Wisconsin and Froedtert Health), announced the selection of a new administrator. Just one component in the broader array of mental health services in Milwaukee County, the emergency center will serve as a national model for emergency crisis care that is patient‐centered, recovery‐oriented and culturally informed, a news release stated. Kevin Kluesner has been selected as the administrator of the new Mental Health Emergency Center, effective Oct. 11. Targeted to open in early 2022, the Mental Health Emergency Center will offer 24/7 crisis mental health assessment, stabilization, treatment and transition care management for children, adolescents and adults. “Our community and our nation's mental health services have long been underfunded and fragmented,” said Kluesner. “This opportunity to help create an innovative mental health emergency center and quickly integrate it into Milwaukee's mental health care continuum will be important and fulfilling work. I'm looking forward to establishing and maintaining strong relationships with the Mental Health Emergency Center's stakeholders and the Milwaukee community.”

Role of digital health in improving physical and mental well-being during COVID-19 pandemic

IntroductionDue to the COVID-19 pandemic, there is a steep rise in the acceptance of telemedicine and digital health, including increased interest in pursuing mental health treatment through telepsychiatry. Digital health helps following social distancing measures and increases the health outcomes.ObjectivesTo see the role of digital health in improving physical and mental well-being during COVID-19 PandemicMethods This study is a part of a large global project where 240 people inquired advice on phone app during COVID-19-Pandemic. Later on, a short study was conducted on the same population through survey to evaluate the effectiveness of digital health/tele-mental health. We also searched PubMed, Google Scholar, PsychInfo, and Medline for words “Digital Health, Tele-mental health, COVID-19-Pandemic”. Reviewed 40 articles and included 3 in this review1,4,5.Results We received a total of 98 responses. 65.6% people reported that online health resources are helpful in relieving pandemic-induced anxiety/stress, 66.2% reported to continue online health services after pandemic, 37.7% noted that digital health saves times in waiting areas, 46% reported lack of physical interaction with doctor as a disadvantage of digital health, and 40.3% reported comfort in using tele-mental health. Our literature review has shown barriers like privacy concerns and technological issues1. Provision of tele-psychiatry is safe and effective in continuity of mental health care.4,5Conclusions There has been an increased inclination towards digital health during any disaster. During COVID-19-Pandemic, digital health has increased access to mental health care and reduced risk of infection. The drawbacks include poor patient-doctor relationship, reimbursement concerns, and lack of confidentiality.

Supporting the wellness of laity: clinicians and Catholic deacons as mental health collaborators

ABSTRACT Religion is a salient part of cultural competence for mental health clinicians. This paper describes rationales for clinicians to work with a less well-known Catholic clergy: permanent deacons. Demographic, personality structure and religious commitment data from nearly 2,000 deacons support collaboration with clinicians to improve the continuity of mental health care. Guidelines for this work are provided by the Clergy Outreach & Professional Engagement (COPE) model: clergy first support mental health without clinicians, then clergy may need to reach out to clinicians, then clinicians may need to reach out to clergy to provide care salient to persons of religious faith and to help sustain recovery. Deacon examples are provided throughout the paper. Future research is recommended.

Mental Health Service Utilization Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men in HIV Care: A Retrospective Cohort Study.

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) face multiple psychosocial stressors, and are disproportionately impacted by HIV. Mental health care engagement is a promising avenue for addressing these disparities. To date, rates of mental health service utilization have not been examined specifically in this population. We conducted a retrospective cohort study among YB-GBMSM receiving care in a Ryan White-funded HIV care center that includes co-located HIV and mental health services. Of 435 unique YB-GBMSM patients, mental health concerns were identified in n = 191 (43.9%). Depressive symptoms were the most common concerns identified, followed by substance use, anxiety, and trauma. Among patients with identified mental health concerns who were not previously in mental health care, 79.1% were referred to mental health care, 56.3% set an appointment with a mental health provider, 40.5% were linked to mental health care (attended an initial visit), and 19.6% remained engaged in mental health care. Younger YB-GBMSM (age 18-24 years), who received care in a more integrated pediatric/adolescent part of the center, were more likely to have an appointment set once a concern was identified (χ2 = 7.17; p = 0.007). Even in a setting with co-located HIV and mental health care services, we found significant gaps in engagement at each stage of a newly described mental health care continuum. Implications for intervention at the provider and systems levels are discussed.

Continuity of Mental Health Care at Community Health Centers and Reduced Emergency Department Visits for Suicidal Ideation/Self-Harm.

We examined whether county-level increases in continuity of mental health care(i.e., mental health visits per mental health patient)at Community Health Centers (CHCs) correspond with adecline in Emergency Department (ED) visits for suicidal ideation and self-harm (1) overall, and (2) among specific race/ethnicities across 211 counties from 10 USstates, from 2006 to 2015 (sample size = 1412 county-years). We used fixed effects linear regression analyses with county-level socioeconomic covariates and year indicators. In the full sample, continuity of mental health care at CHCs varies inversely with ED visits for suicidal ideation/self-harm (coefficient: -0.04, p < 0.1). Race-specific analyses show that a one unit increase in continuity of mental health care at CHCs corresponds with a 5% decline in ED visits for suicidal ideation/self-harm among whites (p < 0.05). Expansion of mental health care services at CHCs may serve as a key point of prevention for suicidal behavior.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Forensic mental health service implications of COVID-19 infection in Nigeria

Forensic mental health services are fledgling in most African countries including Nigeria. The current formulation of such services in Nigeria is correctional psychiatry in addition to some hospital-based services. The COVID-19 pandemic presents significant challenges to the already fragile state of forensic mental health services within the country. Its impact includes limitation of access to and continuity of mental healthcare in prison as well as reduction in referrals from other services within the criminal justice system such as the police and the courts. Further tapering of previously less prominent aspects of forensic mental health service in the country such as the preparation of psychiatric court reports has also been observed. Forensic psychiatry training and research have equally been hampered by the pandemic. The lessons learnt from these challenges should offer practitioners and policy makers insight into strategic developmental objectives for the post-COVID era within services and training programmes.

The Importance of Video Visits in the Time of COVID-19.

The Importance of Video Visits in the Time of COVID-19.