Continuity Of Mental Health Care Research Articles

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.

The Vital Role of a Full Continuum of Psychiatric Care Beyond Beds.

The authors make the case for expanding the national discussion of inpatient psychiatric beds to recognize and incorporate other vital components of the continuum of care in order to improve outcomes for individuals with serious mental illness. They review the varied terminology applied to psychiatric beds and describe how the location of these beds has changed from primarily state hospitals to the criminal justice system, emergency departments, inpatient units, and the community. The authors propose 10 recommendations related to beds or to contextual issues regarding them. The recommendations address issues of mental illness terminology, criminal and juvenile justice diversion, the Emergency Medical Treatment and Labor Act, mental health technology, and the mental health workforce, among others. Each recommendation is based on findings from publicly available data and clinical observation and is intended to reduce the human and economic costs associated with severe mental illness by promoting a robust, interconnected, and evidence-based system of care that goes beyond beds.

Racial Disparities in Pediatric Psychiatric Emergencies: A Health Systems Approach.

Less than half of African American youth with severe mental disorders receive psychiatric care. When they do receive care, African American youth use the Emergency Department at higher rates than whites. We examine whether rapid expansion of primary mental health care at Community Health Centers reduces Emergency Department visits for psychiatric care especially among African American youth. Through four studies, we examine (1) the impact of mental health service capacity on the disparity of psychiatric care among African American youth; (2) how Community Health Center mental health visits vary with repeat psychiatric emergency visits; (3) the county-level drivers of the expansion of Community Health Centers; and (4) how Community Health Center expansion affects overall psychiatric emergency care. Results indicate that increased continuity of mental health care at Community Health Centers corresponds with a reduction in racial disparities in youth psychiatric ED visits. In addition, an increase in Community Health Center capacity varies inversely with repeated psychiatric Emergency Department visits and inversely with psychiatric Emergency Department visits overall. And finally, results show an increase in Community Health Center mental health services among counties with greater poverty, lower physician availability, and higher percentage of uninsured. Our studies indicate that expansion of federally-funded primary mental health services affects the overall system of emergency psychiatric care. However, this expansion does not appear to dramatically reduce racial/ethnic disparities in psychiatric emergency department visits.

Decriminalization in action: lessons from the Los Angeles model.

Los Angeles County's Office of Diversion and Reentry (ODR) has removed over 3800 people from the largest jail system in the country. Across various diversion programs, ODR's fundamental goal is to provide permanent, lifetime care for each diverted person. This article describes ODR's various diversion programs, and elucidates the types of elaborate clinical and court-related interventions that are necessary to remove persons with serious mental disorders from jail custody. As Los Angeles continues to build the necessary community-based continuum of mental health care, ODR's model proves that thoughtfully removing persons with serious mental disorders from jail is possible and necessary for the health of both patients and community.

DEVELOPMENT OF A NEUROBEHAVIORAL PSYCHIATRY CONTINUUM OF CARE FOR CHILDREN WITH ASD, INTELLECTUAL DISABILITY, SEVERE BEHAVIORS, AND MENTAL ILLNESS

In this Clinical Perspectives, we will discuss the development of a multidisciplinary neurobehavioral mental health care continuum for patients within the Cincinnati Children’s Hospital Medical Center (CCHMC) system for any youth (ages 2–22 years) with a diagnosis of ASD or any youth with an intellectual disability (ID).

Increasing Mental Health Care Access, Continuity, and Efficiency for Veterans Through Telehealth With Video Tablets.

In 2016, the Veterans Health Administration (VHA) began distributing video-enabled tablets to veterans with access barriers. This study evaluated the implementation of this initiative for veterans with mental health conditions, including the impact of tablet receipt on access to and continuity of mental health care, missed opportunities for care, and use of urgent care. A retrospective matched cohort study was conducted, matching tablet recipients with diagnoses of mental disorders (N=728) to a comparison group (N=1,020) on the basis of sociodemographic characteristics, mental health utilization and diagnoses, and wireless coverage. A difference-in-differences approach was used to compare 6-month pre-post changes in number of psychotherapy and medication management visits, continuity of psychotherapy based on VHA's quality metric for mental health care continuity, missed opportunity rate (i.e., the proportion of mental health appointments that were missed or canceled), and probability of any and number of emergency department (ED) or urgent care visits. Compared with the matched control group, tablet recipients experienced an increase of 1.94 (p<0.001) psychotherapy encounters, an increase of 1.05 (p<0.001) medication management visits, an 18.54 percentage point (p<0.001) increase in their likelihood of receiving recommended mental health care necessary for continuity of care, and a 20.24 percentage point (p<.001) decrease in their missed opportunity rate in the 6-month period following receipt of tablets (or the index date for the matched sample). No significant differences in ED or urgent care use were found. Distributing video-enabled tablets to veterans with mental health conditions appeared to improve access to and continuity of mental health services while also improving clinical efficiency by decreasing missed opportunities for care.

Exploring Perceptions of Continuity of Care Among People With Long-Term Mental Disorders in Denmark.

Continuity of mental health care is central to improve the treatment and rehabilitation of people with mental disorders. While most studies on continuity of care fail to take the perspectives of service users into account, the aim of this study was to explore the perceived meanings of continuity of care among people with long-term mental disorders. Fifteen service users participated in semi-structured in-depth interviews. We used template analysis to guide the analysis. The main transversal themes of continuity were "Navigating the system" and "Connecting to people and everyday life." While the first theme related to the participants' experiences of their interaction with the mental health care system, the latter related to their hopes and perceived opportunities for a good life as desired outcomes of mental health care. We conclude that efforts to improve continuity of mental health care should be tailored to the priorities of service users.

Addressing organizational barriers to continuity of care in the Danish mental health system – a comparative analysis of 14 national intervention projects

Background: Continuity of mental health care is central to improve the conditions of people with enduring mental disorders. In Denmark, several government-funded projects on the improvement of continuity of mental health care have been initiated since 2009.Aim: The aim of this study was to investigate how national intervention projects on continuity of mental health care have addressed major barriers for continuity of care and extract general learning points from the projects on the improvement of continuity of care.Method: The study was designed as a thematic document analysis of external evaluations of 14 major national projects on the improvement of continuity of routine mental health care from 2009 to 2017. The data material was processed through thematic coding and comparative analysis.Results: The analysis was organized around four main barriers for continuity: Lack of models for collaboration, different professional cultures and methods, lack of channels of communication, and intersectoral differences in management, economy, and legislation. The first three barriers were addressed in a predominant part of the projects through development of collaborative models, common tools and communication systems. The latter structural barrier was not addressed in any of the projects.Conclusion: There is an ongoing need to address barriers for continuity of mental health care. So far, there has been a much larger focus on organizational, cultural and communicational aspects of continuity than on structural aspects. The study calls for an increased focus on how changes in existing managerial, economic and legislative structures can improve continuity of care.

Looking Beyond Distress: A Call for Spanning the Continuum of Mental Health Care.

BackgroundDespite mental health’s definition as a state of well-being, mental health research and practice has often narrowly focused on pathology and distress. The identification, treatment, and rehabilitation of mental illness are the primary activities pertaining to the role of mental health professionals, but only focusing on these primary activities carries the risk of neglecting other legitimate responsibilities related to prevention of illness and promotion of wellness. Therefore, it becomes important to highlight the potential utility of separately examining levels of distress, alongside levels of well-being in community samples. The goal of this study was to determine the extent to which low levels of distress or a lack of significant distress co-occurs with high levels of well-being in a sample of urban Indian adults.MethodsStandardized measures of psychological distress, along with measures of emotional, psychological, and social well-being, were used in a sample of 300 adults aged 20 to 60 years. The participation of community-dwelling adults who could respond to the questionnaires in English or Hindi (the most widely spoken and official language in India) was solicited through posting announcements on various platforms in a metropolitan city in Southern India. The participants had the option to respond to the questionnaires via a paper-pencil version or through an online Google survey. Psychological distress was assessed using the Kessler Psychological Distress scale (K-10) on which a score over 19 indicated significant distress. We used the 25th and 75th percentile points on the respective distributions of scores to determine high, low, and moderate ranges on the three measures of well-being.ResultsBoth men and women were well represented in the sample (47% and 53%, respectively). Approximately 41% were young adults, nearly 30% were in the 36 to 45-year age group, and 30% were in the 46 to 60-year age group. Approximately 48% of the overall sample (N = 143) exhibited an absence of significant distress. Patterns of well-being were examined in this group of low-distress participants. Only 13% of low-distress participants exhibited high emotional well-being (i.e., had a high positivity ratio) and high psychosocial functioning (i.e., had high psychological and social well-being). As many as 37.8% exhibited low well-being on at least one of the three measures of well-being, despite being low on distress. In other words, low well-being scores were fairly common in conjunction with non-significant levels of distress.ConclusionReliance on low distress for operationalization of mental health may mask lower levels of emotional well-being and psychosocial functioning in a given population. The findings underscore the need to span the entire continuum of mental health care by routinely including preventive and promotive aspects in research and practice.

Implicit Bias and Mental Health Professionals: Priorities and Directions for Research.

This Open Forum explores the role of implicit bias along the mental health care continuum, which may contribute to mental health disparities among vulnerable populations. Emerging research shows that implicit bias is prevalent among service providers. These negative or stigmatizing attitudes toward population groups are held at a subconscious level and are automatically activated during practitioner-client encounters. The authors provide examples of how implicit bias may impede access to care, clinical screening and diagnosis, treatment processes, and crisis response. They also discuss how implicit attitudes may manifest at the intersection between mental health and criminal justice institutions. Finally, they discuss the need for more research on the impact of implicit bias on health practices throughout the mental health system, including the development of interventions to address implicit bias among mental health professionals.

Factors in Maintaining a Stable Patient-Physician Relationship among Individuals with Schizophrenia.

This study aimed to determine whether adequate continuity of care (COC) existed among individuals with schizophrenia, and what the associated determinants were. The National Health Insurance Research Database of Taiwan was used to identify individuals with newly diagnosed schizophrenia from 2000 to 2009. Two outcome indicators were first derived to conduct the continuity assessment based on the usual provider continuity (UPC) index and the continuity of care index (COCI). The average scores of the UPC and COCI were 0.78 and 0.67, respectively. Patients who have been hospitalized, with lower income, and unemployed had significantly poorer continuity of care. In addition, patients were cared for by higher caseload physicians, treated at mental health specialty institutions, and at hospital outpatient settings also experienced significantly poorer continuity. Patients cared for by middle-aged physicians, psychiatrists, and treated at private institutions had significantly better continuity of mental health care.

Decision support systems for assessing integrated mental health care: the refinement toolkit

This symposium aims to present three mental health system evaluation tools which were developed for the Refinement project. The REFINEMENT (REsearch on FINancing systems’ Effect on the quality of MENTal health care) project had the purpose to study the relationship between different European models of health care financing and the extent to which mental health care services meet the goals of high quality, equity, efficiency and better long term health outcomes. This project was financed for 3 years by the European Commission within the 7th Framework Programme from 2011 to 2013.The Refinement project researchers used these tools in order to analyze eight European countries with very different stages in the development of mental health care, considering different balances between community and institutional care: Austria, England, Finland, France, Italy, Norway, Romania and Spain. This symposium will include results of the analysis carried out in these countries. This tool set provides useful and essential knowledge for the evidence–informed mental health planning and policy making in Europe.Describing and mapping the mental health services: THE REFINEMENT MAPPING SERVICES TOOLKIT (REMAST)The REMAST/DESDE-LTC tool aims at analyzing the spatial dimension of mental health care delivered by health and social services by means of Geographical Information System (GIS). The REMAST includes the standardized description of mental health care through the DESDE-LTC; a Service Inventory to collect complementary information; a detailed description about policies, plans and structural organizations of different mental health care services; and the Verona SES Index to describe the areas socio-economically. All data collected is utilized for the creation of specific maps in order to describe the spatial context of all mapped services.The influence of provider payment mechanism on continuity and coordination of mental health care: THE FINANCING &amp; INCENTIVE TOOLKIT (FINCENTO)The FINCENTO tool focuses on the description of financing mechanisms for mental health care, and the identification of financial incentives/disincentives in provider payment mechanisms. The tool is intended to help in examining the impact of financial incentives/disincentives for providers and users/consumers in order to explore their effects on quality of care for people with mental health needs, including the appropriateness of pathways for people with mental health problems through the specialist mental health and general health care systems.Studying the pathways of mental health care: THE REFINEMENT PATHWAYS TOOLKIT (REPATO)REPATO (REfinement PAthways Tool) is an instrument for collecting empirical knowledge on pathways of service utilisation of persons with mental health needs, including the identification and comparison of typical patterns of service use in a wide variety of health and social care systems, identifying factors that possibly influence these patterns of service use, and assessing whether the identified pathways conform to quality of care in terms of continuity of care. REPATO consist of three main parts: (1) service utilisation patterns within primary care, and also between primary care and specialist mental health care, (2) continuity of mental health care and (3) readmission following acute psychiatric hospitalisation. Understanding the pathways of care that individuals follow within a mental health system can support the understanding of impact of different financial incentives and disincentives, as well as of issues around continuity of care.

Who Are the Young People Choosing Web-based Mental Health Support? Findings From the Implementation of Australia's National Web-based Youth Mental Health Service, eheadspace.

BackgroundThe adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia’s national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type.ObjectiveThe objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center.MethodsDemographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015).ResultsMore eheadspace than headspace center clients were female (78.1% compared with 59.1%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6% compared with 73.2%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients.ConclusionsThe findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care.

Spatial Shift in the Utilization of Mental Health Services After Hurricane Sandy Among New York City Residents Enrolled in Medicaid.

Closure of several New York City (NYC) hospitals after Hurricane Sandy caused an unanticipated, extended surge in patient demand at open hospitals. This study identified hospitals with a significant increase in mental-health-related emergency department, inpatient, and outpatient visits from Medicaid patients displaced by Hurricane Sandy. NYC Medicaid patients were classified into non-mutually-exclusive geographic categories corresponding to residence in areas served by Bellevue Hospital Center and Coney Island Hospital, the hurricane impact area, and all of NYC. For each geographic region, we compared the observed to the expected number of service visits in the 6 months after the storm. The expected number of visits was calculated from 2-year trends in mental health claims. Twenty-four facilities in all 5 NYC boroughs experienced patient redistribution from storm-affected areas. Eighteen facilities had a concurrent surge in total Medicaid patients, which suggested that redistribution had a greater impact on resource use at these locations. The redistribution of Medicaid patients after Hurricane Sandy increased mental health service utilization at facilities not near flooded areas. Our findings can aid in surge capacity planning and thereby improve the continuity of mental health care after a natural disaster. (Disaster Med Public Health Preparedness. 2016;10:420-427).

Use of Mental Health Services by Youths and Young Adults Before and During Correctional Custody: A Population-Based Study.

The authors measured use of mental health services among young people before and during incarceration. Administrative data were used to describe mental health services received by 13,919 youths and young adults (ages 12-24) while incarcerated in Ontario, Canada, correctional centers (physician visits, April 1, 2010-March 31, 2012) and, for a subset of the population, during the five years prior to incarceration. Forty-two percent had a mental health-related visit during incarceration. Thirty-five percent had no mental health contact for five years before the beginning of the correctional episode. Forty percent of individuals with schizophrenia had a psychiatric hospitalization in the year before entering custody. For one-third of young people with a mental health visit while incarcerated, the visit was the first mental health contact in at least five years. Yet high use of psychiatric services before entering custody among individuals with schizophrenia may indicate gaps in continuity of mental health care.